Released 2016 health.govt.nz
Framework for
Psychosocial
Support in
Emergencies 2016
Citation: Ministry of Health. 2016. Framework for Psychosocial Support in Emergencies.
Wellington: Ministry of Health.
Published in December 2016
by the Ministry of Health
PO Box 5013, Wellington 6140, New Zealand
ISBN 978-0-947515-94-2 (online)
HP 6524
This document is available at health.govt.nz
This work is licensed under the Creative Commons Attribution 4.0 International licence. In essence, you
are free to: share ie, copy and redistribute the material in any medium or format; adapt ie, remix, transform and build
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Framework for Psychosocial Support in Emergencies iii
Foreword
The Ministry of Health, under the Civil Defence and Emergency Management Order 2015, is the
agency responsible for coordinating the provision of psychosocial support nationally. As part of
that responsibility this update to the Planning for Individual and Community recovery in an
Emergency Event was commissioned through Massey University’s Joint Centre for Disaster
Research.
The Joint Centre for Disaster Research undertakes multi-disciplinary applied teaching and
research role who provided a team of researchers and writers to produce this current version.
Through international research and a comprehensive peer review process across a number of
respected and renowned subject matter experts from across the globe, we can be assured that
the contents of this framework will provide the most accurate and current thinking for
psychosocial support across our communities in the time of an emergency and beyond.
In light of events recently affecting not only New Zealand, but many parts of the world, this
framework will provide the basis in planning for psychosocial support for government
departments, other organisations and agencies operating within the emergency management
sector.
We know emergencies can strike at any time and with any frequency so the application of this
framework and its contents will significantly enhance how our communities cope with and
recover from those emergencies. It is those communities we are charged to care for and protect
who should benefit from this document.
John Crawshaw Charles Blanch
Director of Mental Health Director Emergency Management
iv Framework for Psychosocial Support in Emergencies
Acknowledgements
The Joint Centre for Disaster Research review team would like to acknowledge the significant
contribution of the technical advisory group:
Professor Richard Williams, Emeritus Professor of Mental Health Strategy, Welsh Institute
for Health and Social Care, University of South Wales
Professor Beverley Raphael, Professor of Psychiatry and Addiction Medicine, Australian
National University, Emeritus Professor of Population Mental Health and Disasters, Western
Sydney University and Emeritus Professor of Psychiatry, University of Queensland
Professor Kevin Ronan, Foundation Professor in Psychology and Chair in Clinical
Psychology, School of Health, Human and Social Sciences, Central Queensland University
Dr Garry Stevens, Senior Lecturer in Humanitarian and Development Studies,
and Research Fellow, Centre for Health Research, University of Western Sydney
Dr Melanie Taylor, Senior Lecturer in Organisational Psychology, Department of Psychology,
Macquarie University
Dr Caroline Bell, Associate Professor at the Department of Psychological Medicine,
University of Otago, Christchurch and Clinical Head of the Anxiety Disorders Service,
Canterbury District Health Board
Lucy D’Aeth, Public Health Specialist, Canterbury District Health Board
The review team also appreciates the advice and information provided by its Joint Centre for
Disaster Research colleagues, Dr Christine Kenney and Jon Mitchell.
Framework development and review This framework has been revised and updated to reflect current thinking on psychosocial
recovery following emergencies. The framework was developed under the leadership of the Joint
Centre for Disaster Research in partnership with the Ministry of Health and in consultation with
local stakeholders and international specialists in the field.
In acknowledgement of the importance of evidence-informed policy and practice, an extensive
international literature review formed the basis for much of the framework’s content. This
represents the best evidence available at the time of writing. Given the ever-evolving nature of
knowledge about psychosocial recovery following emergencies, it is advisable that service
providers keep a watching brief to stay up to date with any significant changes in evidence-
informed good practice recommendations.
To keep the Framework for Psychosocial Support in Emergencies aligned with the National
Health Emergency Plan (Ministry of Health 2015), the Ministry of Health will review it within
five years of its adoption. The framework will also be reviewed and updated as required
following any new developments in or substantial changes to the operations or organisation of
New Zealand health and disability services. Such changes may occur if lessons are learned from
a significant emergency affecting the health of communities or the health and disability sector
itself, if new hazards and risks are identified, or if directed by the Minister of Health or Director-
General of Health.
Framework for Psychosocial Support in Emergencies v
Contents
Foreword iii
Acknowledgements iv
Key messages vii
Key concepts ix
Introduction 1
New Zealand emergency context 1
Cultural context 1
Legislative context 2
Scope and purpose 3
Intended audience 4
Guiding principles 5
Psychosocial support 6
Individual and community recovery 8
Psychosocial support across the 4Rs 9
How emergencies affect people 12
Psychosocial reactions to emergencies 14
Short-term reactions 14
Longer-term reactions 16
Risk factors 17
Adaptive factors 21
Strengthening and enabling service delivery 24
Leadership and coordination 25
Roles and responsibilities 25
Planning 26
Training considerations 27
Communication 28
Engaged, informed and resilient communities 29
Information gathering, monitoring and evaluation 30
Delivering psychosocial support 32
Key elements in providing psychosocial support 33
Identification of psychosocial support needs 34
Psychosocial interventions 35
Targeting psychosocial support 39
Mental health treatments 39
vi Framework for Psychosocial Support in Emergencies
Further information on the evidence base 40
References 41
Appendices
Appendix 1: Types of hazards 43
Appendix 2: Typical short-term reactions to emergencies 44
List of Tables
Table 1: Summary of risk factors 17
Table 2: Summary of adaptive factors 23
List of Figures
Figure 1: Psychosocial support in context 7
Figure 2: Tiered model of psychosocial interventions and mental health treatments 9
Framework for Psychosocial Support in Emergencies vii
Key messages
Most people affected by an emergency will experience some level of distress (that is, negative
experiences and emotions that do not indicate problems with psychological functioning). In an
emergency, distress is considerably more prevalent than mental health disorders
and, for most people, the distress is tolerable, short-lived and depends on the duration of
acute and secondary stressors.
All those involved in an emergency are likely to benefit from some form of psychosocial support.
For many, the distress they experience can be eased with the care and support of
families, whanau, friends and the community. Others, however, will need more formal
or professional intervention and a small proportion of people will need specialised
mental health services. This distinction is important as it influences the types of
interventions that should be provided.
The primary objectives of psychosocial recovery are to minimise the physical, psychological and
social consequences of an emergency and to enhance the emotional, social and physical
wellbeing of individuals, families, wha nau and communities. Psychosocial recovery is not
about returning to normality. It is about positively adapting to a changed reality.
Recovery may last for an indeterminate period, from weeks to decades.
Psychosocial support aims to improve psychosocial wellbeing, which refers to three core
domains:
1 supporting and promoting human capacity (strengths and values)
2 improving social ecology (connections and support, through relationships, social
networks and existing support systems of people in their communities)
3 understanding the influence of culture and value systems and their
importance alongside individual and social expectations.
Psychosocial wellbeing depends on having resources from these three domains to respond to
emergency conditions and events. The challenging circumstances can deplete these resources,
resulting in the need for external interventions and help to bolster and build psychosocial
wellbeing for individuals and communities.
People who are affected by emergencies can experience acute and/or chronic distress and may
benefit from psychosocial interventions. Looking back on their experience of those events, those
affected emphasise the importance of interventions that build and sustain supportive
partnerships. Those partnerships may be within families or wha nau, existing or new social and
support networks, or wider communities. Effective interventions to reduce distress after
emergencies should focus on self-efficacy and community participation.
No matter how long the post-emergency period continues, delivering timely and appropriate
psychosocial interventions to support affected individuals and communities must be based on
the accurate assessment of psychosocial problems and associated need. This is
crucial to effectively coordinate and deliver interventions designed to provide psychosocial
support.
viii Framework for Psychosocial Support in Emergencies
Through both preventive and curative actions, psychosocial support can help to
build resilience. Preventive actions are to help prevent or reduce the risk of negative
psychosocial problems. Curative actions involve helping individuals and communities to face
and overcome such problems and to adapt to changing circumstances. In this way, psychosocial
interventions are focused at a population level, as well as informing and supporting individuals.
Psychosocial resilience is a process of adapting positively, of continuing to develop
in response to adversity and change, rather than being a stable goal to be reached. It
involves dynamic interactions between a person and the wider social, physical and cultural
environments, as well as a range of individual characteristics and individual reactions to acute
or chronic stressors.
Social support is the primary adaptive factor consistently identified in research and
reflected in evidence-based practice.
The community’s participation and involvement during ongoing recovery is integral to
building trust and engagement. Strong social infrastructure, such as social connectedness,
networks, social capital, social identity and attachment processes, has an important role in
facilitating emergency response and recovery.
The psychosocial impacts of emergencies are like ripples in a pond, with consequences reaching
out well beyond the main location of the event. Psychosocial support must be the concern
of all providers, locally, regionally and nationally.
Providing effective psychosocial interventions requires:
collaborative partnerships based on clear roles and responsibilities and effective leadership
careful planning
good training and support for personnel at all levels and in all agencies
engaged, informed and resilient communities
effective communication
regular monitoring and evaluation.
Well-coordinated and resourced psychosocial interventions can support many
people in affected communities to adapt after an emergency. Such interventions
can also assist people to help others.
Effective leadership, along with a clear understanding of roles and
responsibilities, will help services that are coordinating, designing and delivering
psychosocial interventions to continue to effectively contribute to post-emergency adaptation
and recovery in the long term.
All agencies and groups providing psychosocial interventions must undertake planning and
preparedness activities to ensure that they can fulfil their roles and contribute to an effective
response and an optimal recovery.
Framework for Psychosocial Support in Emergencies ix
Key concepts
This document uses a number of terms that can have different and/or contested meanings in
different contexts. In this document, these terms have the following meanings.
In keeping with New Zealand legislation and policy, this document uses the term emergency
for situations that pose significant risk to life, health, property, livelihoods or the environment
and that require a coordinated response. By their nature, emergencies have consequences that
are difficult to predict. They can happen anywhere, at any time, with little or no warning, or they
may unfold more slowly, giving people time to take actions to address them. An emergency can
vary in scope, intensity and impact. In most cases, the response must be immediate to prevent
the situation from worsening. The academic and wider literature tends to use the term ‘disaster’
to refer to such events.
Psychosocial reflects the interrelationship between individual psychological and social factors.
The psychosocial approach considers individuals in the context of the combined influence that
psychological factors and the surrounding social environment have on their physical and mental
wellness and their ability to function. Psychosocial support during an emergency (no matter how
long it lasts) is about easing the psychological, social and physical difficulties for individuals,
families, whanau and communities. It is also about enhancing wellbeing and helping people to
recover and adapt after their lives have been disrupted.
Mental health is defined by the World Health Organization as a state of wellbeing in which
every individual realises their own potential, can cope with the normal stresses of life, can work
productively and fruitfully and can contribute to their community.
This document uses mental health disorder to identify conditions, diagnosed most often by a
psychiatrist, that may cause suffering or a poor ability to function in life. Such features may be
persistent, relapsing or remitting, or occur as a single episode. Distress refers to negative
experiences and emotions that do not indicate problems with psychological functioning.
Vulnerability is the degree to which an individual, organisation, community or system is
unable to anticipate, cope with, resist or recover from the impact of hazards. It is important to
recognise that people, including those who are more vulnerable, also have capacities and
competencies. By acknowledging these strengths, which may occur at individual, family,
whanau, community and structural levels, it is possible move beyond the concept of
vulnerability as a label that constructs a particular group as inherently at risk. A strength-based
focus recognises that promoting capacities and competencies can help reduce risk and can aid
recovery and adaptation after an emergency.
Resilience is about adapting positively in the face of disturbance, stress or adversity. The
resilience of individuals and communities is interrelated. Resilience means more than bouncing
back from crisis and challenge; it is dynamic and can be developed and strengthened over time
by engaging and developing the capacity to thrive in environments characterised by change.
x Framework for Psychosocial Support in Emergencies
Psychosocial resilience is a process of adapting positively, of continuing to develop
personally in response to adversity and change, rather than a stable goal to be reached. It
involves dynamic interactions between a person and their wider social, physical and cultural
environments, as well as a range of individual characteristics and individual reactions to acute
or chronic stressors.
The primary objectives of psychosocial recovery are to minimise the physical, psychological
and social consequences of an emergency and to enhance the emotional, social and physical
wellbeing of individuals, families, whanau and communities. Psychosocial recovery is not about
returning to normality. It is about positively adapting to a changed reality. Recovery may last for
an indeterminate period, from weeks to decades.
This document uses psychosocial intervention to refer to all interventions, services and
other initiatives that may be offered to affected individuals, families, whanau and communities
during and after an emergency. These types of interventions tend to focus more on influencing
the psychosocial context and on promoting health and wellbeing. In contrast, individually
tailored treatment packages focusing on mental health disorders are mental health
treatments.
Secondary stressors are circumstances, events or policies that are indirectly related to, or are
a consequence of, an emergency. These secondary stressors can worsen problems that existed
before the emergency, as well as complicate recovery when their impact becomes greater than
the emergency itself.
Framework for Psychosocial Support in Emergencies 1
Introduction
New Zealand emergency context New Zealand communities are exposed to a broad range of hazards – that is, potential or
existing conditions that may harm people (by causing death, injury and illness) and damage
property or the social, economic, cultural and natural environments (see Appendix 1). Three
broad types of hazards are:
1 natural disasters (eg, floods)
2 human-made, non-intentional technological disasters (eg, nuclear accidents)
3 human-made, intentional acts (eg, mass violence and terrorism).
Even where a hazard does not directly affect health or health care services, disruption to critical
services can have serious consequences that can in turn endanger community health and safety
and disrupt health and disability services (Ministry of Health 2015). For example, if a severe
storm disrupts electricity supply over several days, residents may be unable to heat their homes,
adequately refrigerate or prepare food, or boil water if needed, increasing their risk of illness.
Power supplies for critical medicine storage or medical devices, such as sleep apnea machines,
may also be seriously compromised.
It is imperative that health providers understand both the hazards and the risks that
communities and the health and disability sector face. Only then can they make informed
decisions about how to manage and reduce risk and develop the capabilities needed in an
emergency. Risk is a function of the hazards to which a community is exposed and the
vulnerabilities of that community, which are modified by its level of resilience.
The Sendai Framework for Disaster Risk Reduction 2015–2030 (United Nations Office for
Disaster Risk Reduction 2015) highlights concerns about human health and wellbeing that are
common across disaster risk reduction, climate change and sustainable development. The
framework aims to substantially reduce disaster risk and losses in lives, livelihoods and health
and in the economic, physical, social, cultural and environmental assets of people, businesses,
communities and countries. One significant focus is on public health, including enhancing
recovery schemes to provide psychosocial support for all people in need.
Cultural context Given New Zealand’s culturally diverse population, it is important to recognise and respect the
importance of culture following an emergency. Culture determines how we interpret events and
relate to people. It also shapes our beliefs about what is, and is not, right to say and do.
Māori models of health acknowledge the importance of thinking about waiora – overall
wellbeing – in a holistic way. Waiora recognises the spiritual, social and cultural aspects of
wellbeing.
2 Framework for Psychosocial Support in Emergencies
The importance of psychosocial support is embodied in the health model Te Whare Tapa Whā
(Durie 1998). This model relates the four sides of the whare (house) to different forms of
wellbeing:
Hinengaro support (mental and emotional wellbeing)
Wairua support (cultural and spiritual wellbeing)
Tinana support (physical, practical and financial wellbeing)
Whanau support (advocacy and extended family or whanau wellbeing).
The model Te Pae Mahutonga (Southern Cross Star Constellation) brings together elements of
modern health promotion (Ministry of Health 2016). The four central stars of the Southern
Cross represent four key tasks of health promotion:
Mauriora (cultural identity)
Waiora (physical environment)
Toiora (healthy lifestyles)
Te Oranga (participation in society).
The two pointers represent Ngā Manukura (community leadership) and Te Mana Whakahaere
(autonomy).
These models provide a useful context for thinking about wellbeing after an emergency. In line
with He Korowai Oranga: Māori Health Strategy (Ministry of Health 2002), this framework
for psychosocial support is based on:
partnership – working together with iwi, hapū, whanau and Māori communities to develop
strategies for Māori health gain and appropriate health and disability services
participation – involving Māori at all levels of the health and disability sector, including in
decision-making, planning, development and delivery of health and disability services
protection – working to ensure Māori have at least the same level of health as non-Māori,
and safeguarding Māori cultural concepts, values and practices.
Pacific peoples from many Pacific Island nations call New Zealand home and each ethnic group
has its own traditions, languages, values and beliefs. The traditional Pacific view is based on a
holistic collective approach in which wellbeing requires equilibrium of mind, body, spirituality,
family and the environment (Kingi-Uluave et al 2007).
Legislative context The roles and responsibilities of New Zealand government agencies in an emergency are
outlined in the National Civil Defence Emergency Management Plan Order 2015 (the National
CDEM Plan). In line with sections 39–47 of the Civil Defence Emergency Management Act
2002, the National CDEM Plan aims to integrate and align agencies’ civil defence and
emergency management planning and related operational activities at the national level.
Key planning documents relating to psychosocial support include:
Guide to the National CDEM Plan (Ministry of Civil Defence and Emergency Management
2015a)
Welfare Services in an Emergency: Director’s guideline for CDEM Groups and agencies
with responsibilities for welfare services in an emergency (DGL 11/15) (Ministry of Civil
Defence and Emergency Management 2015b)
Framework for Psychosocial Support in Emergencies 3
National Health Emergency Plan (Ministry of Health 2015)
Framework for Psychosocial Support in Emergencies (this document)
New Zealand Influenza Pandemic Plan (Ministry of Health 2010).
Under the National CDEM Plan, the Ministry of Health became responsible for coordinating
psychosocial support for emergencies. The National Health Emergency Plan provides the
overall strategic framework and guidance for the health and disability sector in planning for,
responding to and recovering from health-related risks and consequences of significant hazards.
This document is one of a collection of guidance documents and action plans covering specific
aspects of emergency management that add to the National Health Emergency Plan. For the
latest electronic versions of all of these subsidiary and related documents, go to the Ministry of
Health website (www.health.govt.nz/our-work/emergency-management).
Within Welfare Services in an Emergency: Director’s guidelines (Ministry of Civil Defence and
Emergency Management 2015b), psychosocial support is one of nine welfare sub-functions:
registration
needs assessment
inquiry
care and protection services for children and young people
psychosocial support
household goods and services
shelter and accommodation
financial assistance
animal welfare.
To recognise and respect the principles of the Treaty of Waitangi, the New Zealand Public
Health and Disability Act 2000 outlines mechanisms health providers can use to effectively
engage with Maori to address the relationships and obligations that come from the Treaty of
Waitangi. All agencies, service providers and community groups involved in planning,
coordinating and delivering psychosocial support need to consider these mechanisms.
Scope and purpose This Framework for Psychosocial Support in Emergencies is designed to help those involved in
planning, coordinating and delivering psychosocial interventions and mental health treatments
in an emergency.
Practitioners and service managers are encouraged to read this document from start to finish so
that they understand the context of psychosocial support in emergencies in New Zealand. We
suggest keeping this document at hand as a resource to refer to when needed: to plan service
design and delivery; for collaborative planning; for emergency action; and during exercises.
The framework:
identifies the need to provide psychosocial support interventions for individuals, families,
whanau and communities that are appropriate to their identified needs
identifies the need to provide mental health treatment (in primary and secondary care) for
those who need it
describes the impact of emergencies on people’s psychological and social wellbeing
4 Framework for Psychosocial Support in Emergencies
describes the importance of targeting services so that they meet the needs of all potentially
affected members of the community
outlines the principles and considerations that should underpin psychosocial interventions
and mental health treatments offered to affected individuals, families, whanau and
communities during and after an emergency
describes the available evidence base for psychosocial interventions
highlights the importance of addressing longer-term needs, including those resulting from
secondary stressors
promotes a focus on enabling and engaging communities, including by building on existing
local resources and capacities
promotes information gathering, monitoring and evaluation to ensure that the investments,
services and initiatives put in place for individuals and communities assist them in their
psychosocial adaptation and recovery.
Intended audience This document is for all agencies, service providers and community groups involved in planning,
coordinating and delivering psychosocial support. Relevant providers and groups include:
all district health boards in their capacities as governance bodies, lead entities and service
providers, including public health units
all health providers throughout New Zealand, including providers of primary care, aged care
and disability support, and other non-governmental providers such as pharmacies
Maori health providers
hapu and iwi Maori, marae communities and organisations
organisations that provide psychosocial support services and initiatives, including but not
limited to Red Cross and Victim Support
organisations that provide health care information and signposting services, such as
Healthline
agencies that interact with these providers, such as ambulance, fire and police services
community-based organisations and voluntary community groups, including (but not limited
to) faith-based groups, culturally and linguistically diverse community groups, service
organisations, groups working with vulnerable people, and people with disabilities (including
those for whanau, families) and rural networks, providers or groups
Ministry of Civil Defence and Emergency Management
Civil Defence emergency management groups
Ministry of Education, which oversees schools and early childhood services
Ministry for Primary Industries, which funds rural support trusts and other organisations to
provide psychosocial support to rural communities
Te Puni Kōkiri, which provides links to iwi and Māori providers and advice on appropriate
cultural responses.
Framework for Psychosocial Support in Emergencies 5
Guiding principles The guiding principles for health and disability services providing psychosocial support after an
emergency are listed here. These principles are drawn from the evolving evidence base on the
process of psychosocial recovery, and align with international best practice guidelines and the
overarching principles in the National Health Emergency Plan (Ministry of Health 2015).
Do no harm: No action, intervention or other service response should cause harm. Wherever
possible, they should promote: a sense of safety; self and community efficacy; empowerment;
connectedness; calm and hope.
Human rights and health equity: Establish, maintain and develop psychosocial support
interventions that are best able to meet the needs of patients/clients and their communities
during and after an emergency, even when resources are limited. Promote the human rights of
all affected people and make provisions for vulnerable people and hard-to-reach communities so
that recovery actions do not create or increase inequalities.
Community and stakeholder engagement: In all actions, including those to plan and
determine needs, actively gain maximum levels of participation from local, affected populations.
Promote self-help: In all actions, encourage individuals and communities to care for
themselves and others and to seek further help. These actions should also help to restore
people’s agency and perceptions of themselves as effective individuals.
Integrated all-agencies approach: Develop and maintain effective, trusting relationships
both in the health and disability sector and with community partners to develop and provide
collaborative and coordinated psychosocial support interventions that are jointly owned by
affected individuals, communities and the agencies involved.
Multi-layered targeted support: Develop and provide a layered system of adaptive
psychosocial support interventions that are implemented together to meet the needs of different
individuals and groups and that can be provided on a larger or smaller scale if needed. These
should fully consider the unique, complex and dynamic nature of emergencies and of
communities.
Continuous improvement: All agencies undertake continuous improvement, through
ongoing monitoring and review and by translating lessons learned through research and
experience into integrated, ethical policy, plans and services. Continuous improvement includes
education and training, professional development, review, evaluation, ethical practice and
community involvement.
Response and recovery workers: Acknowledge both paid and volunteer workers and take
steps to protect them from harm. This protection should cover the risk of both acute and
cumulative impacts on their psychosocial and mental wellbeing.
6 Framework for Psychosocial Support in Emergencies
Psychosocial support
Psychosocial support aims to improve psychosocial wellbeing, which has three core domains:
1 support and promote human capacity (strengths and values)
2 improve social ecology (connections and support, through relationships, social networks
and existing support systems of people in their communities)
3 understand the influence of culture and value systems and their importance alongside
individual and social expectations.
Psychosocial wellbeing depends on having resources from these three domains to respond to
emergency conditions and events. The challenging circumstances can deplete these resources,
resulting in the need for external interventions and help to bolster and build individual and
community psychosocial wellbeing.
The adjective ‘psychosocial’ refers to the psychological, social and physical experiences of
people in the context of particular social, cultural and physical environments. It describes
the psychological and social processes that occur within and between people and across
groups of people (Williams and Kemp 2016, p 83).
An individual’s experience of psychosocial wellbeing is determined largely by the context they
live in. If a person’s immediate surroundings and community are disrupted, they are likely to be
in some discomfort or distress, even if only in the short term. It is unlikely that many individuals
in this situation will be experiencing psychosocial wellbeing. Just as contexts and individual
factors are always changing, so is the experience of psychosocial wellbeing.
This dynamic nature of the experience makes it very difficult to provide a standard definition of
what psychosocial wellbeing is, or how to recognise it. It is therefore critical to understand what
psychosocial wellbeing means locally for an affected population before planning a psychosocial
intervention to improve wellbeing. This is the only way to ensure that planned interventions and
activities are relevant for an affected community, and are not just replicating something that has
been used elsewhere.
Figure 1 outlines the relationship between broader social contexts, the dynamic psychosocial
context and individual psychological factors, and how these may influence physical reactions
and behaviour to shape health and wellbeing. Broad social factors such as economic policy and
culture are relatively resistant and slow to change but can be hugely influential on how people
and communities deal with emergencies. They provide the psychosocial context for the
experience of everyday life – how we experience our communities, families, whānau, schools,
workplaces and neighbourhoods, and our financial resources for doing so. This context includes
our relationships with our peers, and our sense of connectedness with others and with the places
in which we live, work and play.
Framework for Psychosocial Support in Emergencies 7
Figure 1: Psychosocial support in context
This psychosocial context influences, and is in turn shaped by, our personal psychological
experience. This experience consists of our thoughts, feelings and sensations, as well as our
personalities, coping styles and the values that are important to us. Our psychosocial context
also influences our basic biological physical reactions, as well as our behaviour, which then
affects our health and wellbeing.
For example, feelings of threat and being overwhelmed by emergency events over a sustained
period can lead to both acute and chronic production of stress hormones in our bodies (biology).
These hormones can make us feeling tired and compromise our immune system, which makes
us more susceptible to falling ill. These effects can be further compounded when the stress
hormones interfere with our sleep patterns (behaviour), making us feel even more tired and
increasing the risk of poor health and wellbeing.
The social context might also influence the individual experience, for example, if we have a
sense of loss of people or places that are important to us. That sense can produce feelings of
enduring sadness, which in turn can make us more withdrawn and less willing to socialise with
others. This influences our psychosocial context and potentially our health and wellbeing
through our behaviour and biology.
The issue of psychosocial support during and after emergencies is important. People who are
affected by emergencies can experience acute and/or chronic distress and may benefit from
psychosocial interventions. According to the available literature, looking back on their
experience of an emergency, those affected emphasise the importance of interventions that build
and sustain supportive partnerships – whether within families, whanau, existing or new social
and support networks, or wider communities. Effective interventions to reduce distress after
emergencies should focus on self-efficacy and community participation. Evidence suggests that
developing existing and new social networks that help people support each other and foster a
sense of control over their lives is critical for community recovery.
8 Framework for Psychosocial Support in Emergencies
Effective psychosocial support ensures that other aspects of the recovery process (eg, rebuilding)
do not result in further harm to individuals or their communities. It also helps to develop
individual and community resilience as it empowers people to care for themselves and others by
drawing on and developing their capabilities, resources and networks. (See more about
community resilience under ‘Engaged, informed and resilient communities’.)
Through both preventive and curative actions, psychosocial support can help to build resilience.
Preventive action helps prevent or reduce the risk of negative psychosocial problems. Curative
actions involve helping individuals and communities to face and overcome such problems and to
adapt to changing circumstances (see more about individual and community resilience under
‘Adaptive factors’). In this way, psychosocial interventions are focused at a population-level as
well as informing and supporting individuals.
Whanau wellbeing
Family and whanau play an important role in psychosocial recovery and in building
resilience. While this document uses ‘family and whanau’ to mean all aspects of this
important part of the psychosocial context, research suggests that wha nau resilience has a
uniquely Māori interpretation. The research explored the capacity of whanau to overcome
adversity, flourish and enjoy better health and wellbeing. Despite external factors, internal
dynamics and financial pressures that can limit capacity, whanau demonstrated they were
able to respond to these challenges, make use of limited resources, and react in positive
and innovative ways (Waiti and Kingi 2014). The authors suggest a framework consisting
of four resilience themes:
1 whanaungatanga factors (networks and relationships)
2 pūkenga factors (abilities and skills)
3 tikanga factors (meanings, values and beliefs)
4 tuakiri-ā-iwi factors (secure cultural identity).
Individual and community recovery Psychosocial support requires integrated, multi-layered, targeted initiatives, activities and
service coordination that address the complex, dynamic needs of individuals and communities
and that can be scaled up or down as needed. Psychosocial interventions should use a
multidisciplinary approach and be part of primary health care services and the overall
emergency response.
Where possible, use local, trusted providers who have a strong awareness and understanding of
psychosocial wellbeing, understand local circumstances, and are embedded in the affected
communities.
All those involved in an emergency, no matter how they are affected, are likely to benefit from
some form of psychosocial support. For many, their distress in the short term can be eased with
the care and support of family, whanau, friends and the community.
Others, however, need more formal or professional intervention and a small proportion need
specialised mental health services. This distinction is important as it influences the types of
interventions or treatments that should be provided. Figure 2 illustrates this model.
Framework for Psychosocial Support in Emergencies 9
Figure 2: Tiered model of psychosocial interventions and mental health treatments
Source: Adapted from IASC (2007)
Psychosocial support across the 4Rs Psychosocial support considerations should be part of all aspects of emergency management –
risk reduction, readiness, response and recovery. This is the way to provide appropriate, scalable
activities and interventions based on identified need through an integrated, multi-layered,
targeted model of service delivery.
Risk reduction
Risk reduction is about reducing the likelihood of hazards and/or reducing the potential
consequences of those hazards. The health and disability sector has only limited influence on the
probability of a hazard occurring (other than for specifically health-related hazards). However, it
does have the ability and opportunity to lessen the vulnerability of the community and health
and disability sector to hazards more generally and to reduce the consequences of them.
To lower the overall risk of poor psychosocial recovery outcomes, it is necessary to better
understand the vulnerability of individuals, families, whanau and communities, and then take
action to reduce this. All health and disability service providers have a responsibility to work
with partner organisations and the communities they serve to reduce risks and enhance
resilience. Leading, developing, engaging in or delivering community health development
projects and whole-of-community health and disability services will help providers to achieve
these outcomes.
Pre-emergency risk appreciation, reduction & readiness
Specialised
services
(Targeted) Focused, non-
specialised supports
Community and family supports
Basic services and security
Specialist psychological or psychiatric care
Advocacy for basic services.
Information, housing and
income support.
General mental health care (e.g. psychologists, social
workers, counsellors).
Community networks, social
groups, grief support groups, marae-based supports
Me
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10 Framework for Psychosocial Support in Emergencies
Ongoing risk reduction activities include:
building organisational resilience and reducing its susceptibility to hazards through planning
and business continuity management processes
mapping existing psychosocial services and developing relationships with those agencies,
groups and organisations who can contribute to psychosocial recovery.
Readiness
The objectives of emergency readiness are to:
build the capacity and capability of all health and disability services to effectively anticipate,
respond to and recover from the impacts of emergencies
facilitate individual, families, whanau and community response, adaptation and recovery.
Readiness activities must be based on an understanding of hazard risks and sound risk
management principles.
To make sufficient and appropriate resources available for psychosocial response and recovery,
all those involved in developing, providing and maintaining psychosocial support interventions
must identify and address issues specifically related to their capability and capacity.
Emergency psychosocial support interventions should build on the existing clinical skills,
services and preparedness within communities and be integrated with broader community
emergency plans and readiness activities.
Ongoing readiness activities include:
planning, exercising and testing arrangements
training communities and developing appropriate skills within them
monitoring and evaluating capacity and capability to perform across different types of
emergencies.
See more on each of these activities under ‘Strengthening and enabling service delivery’.
Response
Psychosocial support response includes all actions and interventions taken during emergencies
to minimise the psychosocial impacts on individuals, families, whanau and communities.
Agencies must work together to deliver services in a time of crisis and uncertainty. For example,
it may be that people are still missing, the dead are yet to be identified, families are separated
and little information is available.
To deal with such situations, multiple agencies must make effective, integrated responses. Those
responses must be based on a readiness to act; on scalable, flexible and adaptable organisational
structures and capabilities; and on clear, focused communication and information management.
Response activities focus on:
providing for basic physical needs, including need for safety, shelter and appropriate medical
intervention for any injuries
addressing immediate, short-term financial concerns that may be a source of stress
Framework for Psychosocial Support in Emergencies 11
restoring family, whanau, social and community connections
supporting individuals and communities to help themselves and build resilience.
An effective response at all levels will contribute to psychosocial recovery. Part of the success of
the response lies in the way in which services are delivered. For example, services that help to
enhance recovery are those that keep families together by providing emergency or temporary
housing, give children safe spaces in which to play, and have good ongoing communication with
individuals and communities.
Health and disability services should work with partner organisations and affected communities
as they transition from the immediate response to longer-term recovery.
Recovery
The primary objectives of psychosocial recovery are to:
minimise the physical, psychological and social consequences of an emergency
enhance the emotional, social and physical wellbeing of individuals and communities.
Psychosocial recovery is not about returning to normality. It is about positively adapting to a
changed reality. Recovery may last for an indeterminate period, from weeks to decades.
With effective psychosocial support, other aspects of the recovery process (eg, rebuilding) will
not further harm individuals or their communities. It also helps to develop individual and
community resilience as it empowers people to care for themselves and others by drawing on,
and developing, their existing capabilities, resources and networks. People and communities
who are able to care for themselves typically do better than those who expect others to look after
them and who use coping strategies that have been shown to be unhelpful (eg, blaming and
externalising responsibility).
Activities to advance psychosocial recovery may include:
implementing a ‘whole of community’ recovery plan (developed before the emergency); and
reviewing and revising the plan as needed
making clear the roles, responsibilities and referral pathways for delivering psychosocial
support interventions
assessing individuals with ongoing psychosocial difficulties and providing interventions to
meet their needs
monitoring and supporting service providers, who may themselves be affected by the
emergency
continuing to monitor psychosocial support needs in the affected population and provide
those with continuing needs with long-term access to mental health care services
identifying and empowering social and community leaders
providing opportunities for, or enabling, communities to come together
providing work and rehabilitation opportunities for those affected to re-adapt to everyday life
routines and be independent
encouraging and enabling activities that promote self-help among individuals, families,
whanau and communities
anticipating and planning to deal with reminders of the emergency (such as anniversaries)
evaluating and revising psychosocial recovery plans and arrangements.
12 Framework for Psychosocial Support in Emergencies
How emergencies affect
people
Most people affected by an emergency will experience some level of distress – that is, they have
negative experiences and emotions that do not indicate problems with psychological
functioning. During an emergency, distress is considerably more prevalent than mental health
disorders and, for most people, it is tolerable and short-lived, lasting only while acute and
secondary stressors continue.
Importantly, although such reactions can be seen as normal, or within the expected range of
experience, they should not be dismissed. It is possible that such distress masks deeper
community-level reactions that could be related to either:
pre-existing social disparities, which can play a significant role in the ability of particular
groups to immediately respond to and cope with the aftermath of an emergency, or
the impacts of forming and implementing post-emergency policy, which may create new
inequalities and widen existing ones.
It is necessary to analyse the psychosocial context and continue to monitor and assess it in order
to identify and understand any emergent patterns in such responses, and to identify those
needing more psychosocial support. It is also important to investigate and address any
underlying causes that have not been addressed.
Mental health disorders arising from emergencies encompass far more than the experience of
post-traumatic stress disorder (PTSD) or other disorders such as depression or other anxiety
disorders. In most emergencies, the majority of people do not develop significant mental health
disorders. Many people show resilience – that is, they are able to cope relatively well in adverse
situations. Research shows that, on average, 80–90 percent of those who experience some level
of distress tend to return to their regular or usual emotional range, with time, help and the use
of effective coping strategies. Numerous interacting social, psychological and biological factors
influence whether people develop mental health disorders or show resilience in the face of
adversity.
Psychosocial problems in emergencies are highly interconnected, yet specific problems may be
mainly either social or psychological in nature. Significant problems that are largely social include:
pre-existing (pre-emergency) social problems (eg, extreme poverty, political oppression,
belonging to a group that is discriminated against or marginalised)
emergency-induced social problems (eg, separation of family or whanau, disruption of social
networks, destruction of community structures, resources and trust, increased gender-based
violence)
recovery-induced social problems (eg, undermining of existing community structures,
networks or social identity and attachment processes)
the social impact of secondary stressors, which are the circumstances, events or policies that
are indirectly related to or are a consequence of an emergency. Secondary stressors can
worsen social problems that existed before the emergency. They can also complicate recovery
when their impact becomes greater than the emergency event itself.
Framework for Psychosocial Support in Emergencies 13
Similarly, problems that are mainly psychological include:
pre-existing psychological problems (eg, mental health disorder, previous trauma, alcohol
misuse)
emergency-induced psychological problems (eg, mental health disorders caused by degree of
exposure, distress during the trauma, perception of threat to life and grief may lead to
depressive and/or and anxiety disorders)
recovery-related psychological problems (eg, anxiety due to a lack of information)
the psychological impact of secondary stressors (eg, issues with uncertainty, anger associated
with injustice, and loss of health, friends, family, whanau, property, employment).
On the other hand, adaptive factors that give protection and promote recovery and resilience
include:
help from others, which may involve providing information or giving tangible, social or
emotional support
individual coping: sense of safety, hope, efficacy, arousal management (eg, self-soothing
abilities), problem-solving abilities, helpful thinking strategies, emotional coping abilities (eg,
reframing, acceptance, humour), and activities that are pleasurable and give a sense of
mastery, including returning to normal routines
working with, helping and staying connected to others
collective problem solving and collective helping, and keeping up supportive social networks.
Understanding how people behave and their mental health needs before, during and after
disasters and major incidents is of great importance when planning for disasters because
it has implications for how:
societies, communities and families plan and prepare for all kinds of disasters
responsible authorities provide public education and approach working in conjunction
with communities to better understand and respond to their needs and preferences and
ensure their continuing agency in large-scale disasters
governments and responsible authorities communicate with the public before, during
and after events
agencies manage events and respond in the immediate, short- and medium-terms.
(Williams and Kemp 2016, p 84)
14 Framework for Psychosocial Support in Emergencies
Psychosocial reactions to emergencies
Key points
Most people will be affected in some way following an emergency.
Research indicates that the majority of people will recover with time.
Being exposed to an emergency can have a mild or severe, short-term or long-lasting
impact on an individual’s psychological and social wellbeing.
Although the accuracy of data is uncertain because of methodological constraints, a
potentially useful estimate is that up to 15–20 percent of people could be at risk of
developing a mental health disorder after experiencing an emergency.
In complex or recurrent emergencies or those that require a long period of adaptation
afterwards, the risk of developing a mental health disorder may increase to one in three
people.
Most of the estimates in the literature are based on research on the first two years after
an emergency. Estimates become less reliable after this period.
Mental health disorders related to an emergency include post-traumatic stress
disorder, anxiety states, depression, sleep-related problems and substance misuse.
Post-emergency distress and mental health disorders have been associated with
sociodemographic and background factors, event exposure characteristics, social
support factors and personality traits.
The concept of social capital highlights the role of social support (including social
networks, and the norms of reciprocity and trust) in helping to achieve more effective
response and recovery following emergencies.
Short-term reactions Most people will be affected in some way by the experience of an emergency, either directly or
indirectly. People who are affected by an emergency may experience more than one type of
reaction, and reactions are likely to change over time. Adaptation and recovery are unlikely to
happen in a linear way.
After an emergency, people may experience shock, disbelief, numbness, disorientation and
uncertainty about the future. Emotional reactions may be postponed or displaced onto
apparently trivial matters.
In the intense activity required in the aftermath of the emergency, people may lose touch with
their needs and find it difficult to plan, set priorities and make decisions. They may have
problems with concentration, thinking and memory, and may feel overloaded or in a state of
persistent stress.
The range of emotions and reactions experienced along with the disruption to routines, lifestyle,
livelihoods, roles and responsibilities can place significant strain on families, whānau and
communities. Policy developments and/or politically driven actions and their impacts on
different sections of the community may generate concerns and disquiet about potential
negative consequences and equitable treatment. Misunderstanding and confusion may be
fuelled by doubt, scepticism and a lack of trust. These reactions should not be dismissed or
mollified as they may represent real hardships that community members are experiencing.
Steps should be taken to hear any concerns raised and appropriate steps should follow.
Framework for Psychosocial Support in Emergencies 15
Short-term reactions by individuals, families and whānau to an emergency include physical,
emotional, cognitive, behavioural/social and spiritual responses (see Appendix 2 for examples of
each of these). It is important to recognise that such reactions are fairly typical. Provided they
do not last long, these responses can be considered to be normal within an extra-ordinary
context. Indeed, these transitory reactions to emergencies not only are appropriate but, for
some, may well be adaptive.
Short-term reactions are not unusual and can be useful
Many people struggle to make sense of their reactions during and after an emergency.
They can feel unusual and outside their normal experience of sensations, thoughts and
emotions and may be wondering if they are alone in feeling like this. For example, feeling
anxious and afraid during an earthquake is not unusual. Fear is sometimes useful because
it acts like your body’s alarm system. Your body is telling you that you need to be alert and
ready for action. Many people will feel the same way in an emergency. Fear often calms
down reasonably quickly in an emergency once you are feeling safe, but if emergency
events are occurring close together, these feelings may persist for some time.
Helping people to make sense of their experience and to realise that they are unlikely to be
alone in having these feelings can help people to make sense of their reactions and to
normalise them. This kind of help can be given through simple factsheets and/or public
mental health messages. Where individuals have these reactions for more than a few
weeks, it is advisable to refer them for a more thorough assessment for possible
intervention.
Many of these responses may be compounded by sleep difficulties, which is one of the most
widespread problems people report having after emergencies. Several nights of losing sleep,
perhaps just one or two hours a night, reduces our ability to function. People take longer to
finish tasks, have a slower reaction time and make more mistakes, thus increasing the economic
burden on affected communities. Other significant consequences of sleep difficulties are their
detrimental effects on psychological and physical health.
During this time of intense, changing emotions and adjustment, people may also experience
strong feelings of togetherness, altruism and concern. Though based largely on anecdotal
evidence, it appears that early emergent and community-driven responses may promote a
‘honeymoon period’ for a short time (two to three weeks) following an emergency. However,
after this period, people seem to experience fatigue and the community mood drops. A sustained
recovery period is thought to then occur. It would be wise to treat such a pattern as a possibility
but not a certainty during any given emergency and post-event adaptation and recovery period.
The complex characteristics of any hazard and the affected population combined with unknown
secondary stressors as they emerge may lead to different patterns of community impact.
People who are well supported and able to plan and manage their recovery with an
understanding of their whole situation report gaining new or increased wisdom or
understanding, positive shifts in priorities for their lifestyle and value system and new or
strengthened coping skills.
16 Framework for Psychosocial Support in Emergencies
Longer-term reactions While most people who experience an emergency tend to recover with time, others are at risk of
experiencing more severe and long-lasting problems. For some, the impacts of the emergency
may be delayed, only becoming obvious a year or so later. These impacts can include economic
hardship, having to move home repeatedly, the effects of living under prolonged stress, physical
health problems, loss of psychosocial resources (including usual patterns of coping and social
support networks), relationship problems and mental health disorders.
Studies vary considerably in their estimates of the proportion of affected people who go on to
develop mental health disorders. However, evidence suggests that approximately 15–20 percent
of people may be at risk of developing a mental health disorder after an emergency. In complex
or recurrent emergencies or those that require a long period of adaptation afterwards, the risk of
developing a mental health disorder may increase to one in three people (Salguero et al 2011;
North et al 2012; North 2014).
Research on mental health disorders after an emergency focuses on rates of PTSD but also
includes some work on mood-related problems (eg, depression and suicide), anxiety, sleep
problems and additional issues for children and youth. New alcohol and substance use disorders
are rare after disasters and little is known about relapse rates of pre-existing substance use
disorders.
The mental health disorders most typically, but not exclusively, reported after an emergency
include:
depression
anxiety-based symptoms, including acute stress disorder (ASD) and PTSD
sleep problems
prolonged grief
mood disorders, including depression
substance misuse.
In addition, reports of unexplained physical symptoms can increase after an emergency. For
some people, these symptoms are thought to be a proxy for psychological distress where cultural
or perceived stigma may make it challenging for them to directly report thoughts or feelings of
distress.
Many people who develop a mental health disorder may have more than one problem or co-
occurring disorders. This is particularly true for those diagnosed with PTSD. The presence of
comorbidity means that services should be designed and delivered in such a way as to identify
and respond to the full range of people’s needs.
Importantly, much of the current understanding about psychosocial and mental health reactions
to emergencies is based on research focused on individuals. So the findings from this research
cannot be readily generalised to groups, communities or populations. It must be recognised that
psychosocial recovery is a collective activity and a shared responsibility. The overemphasis on
individual responses brings the risk that the importance of group contexts will continue to be
underestimated and undervalued.
Framework for Psychosocial Support in Emergencies 17
Risk factors Long-term adaptation and recovery vary significantly due to the complex interaction of
psychological, social, cultural, political, environmental and economic factors. There is limited
understanding of the nature and extent of the influence of risk and adaptive factors beyond
those factors that are directly related to being exposed to an emergency. Despite a growing body
of knowledge about resilience, risk and adaptive factors, it is difficult to predict who is likely to
recover from their immediate reactions, who may experience sustained distress or who may
develop a mental health disorder. However, it is likely that multiple, repeated or recurrent
emergencies in the future, resulting from increased exposure to hazards such as changing
rainfall patterns, will become an enduring and persistent challenge for psychosocial wellbeing.
For those involved in an emergency, their experience can differ in both type and intensity.
Emergencies challenge the resources and resilience of individuals and communities. Each
person has a unique personal history and set of circumstances that influence their experience of
an event and their response to it. These influences include beliefs, values and resources of the
individual, family, whanau and community. Earlier life circumstances, as well as stressors that
happen after an event but are unrelated to it, can hinder a person’s recovery. The risk factors
identified in the literature (see Table 1) are simply a starting point as issues for consideration.
Service providers must understand the nature and contexts of the communities they serve.
Table 1: Summary of risk factors
Pre-emergency factors
Personal capabilities and attributes
Low levels of personal or social support
Few current attachments
Lack of positive psychological traits (eg, optimism, self-efficacy) believed to buffer stressful life events
Female gender
Age and developmental stage (children and older adults)
Personal experiences
Previous mental health history
Substance misuse problems
Prior exposure to traumatic experiences
Concurrent life stressors, not related to the emergency
Disadvantage (lower socioeconomic status, migrants and marginalised groups)
Characteristics of the emergency
Nature of emergency
Human-made disasters
Sudden and unexpected events
Widespread death and destruction
Exposure to mass violence, grotesque scenes and sensory experiences
Impact of the event
Higher perceived level of threat to life (self or others)
Physical injury
High levels of personal loss (loved ones, possessions, livelihood, pets, livestock, places within which there is social attachment)
Severe disruption to physical environment and community systems
Major property damage
Proximity to and close involvement with the emergency
Serving as an emergency worker/responder
18 Framework for Psychosocial Support in Emergencies
Post-emergency factors
Response to the event
High levels of rumination
Presence of survivor or performance guilt
High and sustained levels of anger
Medical illness, or chronic health problems
Acute stress experiences
Coping via avoidance, self-blame
Coping via substance abuse
Secondary stressors
Compromised/disrupted social and/or family and whanau relationships
Relocation or displacement
Social or relationship problems, marital, family and whanau discord
Adverse reactions from others (eg, blame, neglect, rejection)
Financial pressure and/or vocational problems, unemployment, loss of livelihoods
Problems associated with home relocation, rebuild or repair
Problems arising from seeking and receiving help
Unrecognised or de-legitimised grief (eg, companion animals, livestock, meaningful possessions)
Further losses post-emergency
Source: Adapted from Williams et al (2014) and IASC (2007)
Though an emergency may initially affect a particular geographical area, population movements
may extend the area over which people feel the impacts to neighbouring areas or further afield.
For example, the Canterbury earthquakes saw the largest movement of population in New
Zealand since the Second World War. The consequences for the ‘non-affected’ areas in meeting
the needs of people moving into their region include having to provide schooling and
appropriate residential accommodation, and building the capacity of health and disability
services to meet increased demand. In addition, those areas that are significantly depopulated
may have their own consequences to deal with. It is important that neighbouring regions plan
collaboratively to address these risks, using national resources to deliver complementary and
additional capacity if needed.
The risk of psychiatric morbidity is greatest in those with high perceived threat to life, low
controllability, lack of predictability, high loss, injury, the possibility that the disaster will
recur, and exposure to the dead and the grotesque (Ursano et al 2008, p 1018).
Research has focused on some groups considered to be vulnerable or at greater psychosocial risk
in emergencies, including children and adolescents, older adults, response workers, people with
disabilities, disadvantaged and marginalised groups, people with pre-existing mental health
disorders and those affected by secondary stressors. Key findings about each of these groups are
summarised below.
Children and adolescents
Children and adolescents have distinct vulnerabilities in emergencies, including unique
physiological, psychological and developmental needs. Emergencies can undermine their basic
assumptions about their world being a safe, stable and largely predictable place.
Framework for Psychosocial Support in Emergencies 19
Most children and adolescents exposed to traumatic events are likely to experience some
psychosocial distress, which is generally short lived. For some, these experiences will not
subside spontaneously and will instead become clinically significant, persistent and impairing
mental health problems. These problems may include behavioural and attentional issues,
depression, panic disorder, specific phobias, ASD and PTSD.
Developmental problems such as loss of previously mastered skills, known as regression, may
occur at all ages, including in adults, but are a particular risk for children up to mid-adolescence.
The impacts of regression will be relative to age and level of development.
In very young children, other clinical presentations may include the onset of fears not
specifically associated with aspects of the trauma.
Older adults
Older adults are vulnerable to disproportionately higher health and mental health issues
following emergencies. Compared with younger adults, they are more likely to experience PTSD
symptoms and to develop adjustment disorder. The underlying reasons for this vulnerability are
multifaceted and vary by the type of emergency as well as by individual comorbidities such as
hypertension, diabetes, stroke and heart disease. Other factors, such as the need for prescription
medications, low social support, visual and hearing impairment, diminished mobility and poor
economic status, have also been associated with an increased risk of negative health outcomes.
Older adults may also not seek help, so special care must be taken to care for this group.
However, a focus on older adults needs to be carefully nuanced. Research indicates that in
comparison with those in the 60–74 years age group, those over 75 years of age are more likely to
experience problems associated with access to appropriate health care, rather than problems
associated with being exposed to the traumatic event itself. It is also noteworthy that the
difficulties experienced after disasters seem to be particularly problematic for those aged
40–60 years, as personal, family, wha nau and financial responsibilities tend to peak in middle
age.
Response and recovery workers
A wide range of professional staff, volunteers and organisations play an increasingly important
role in emergencies. Response and recovery workers can include the emergency services (police,
firefighters, paramedics), helicopter pilots, divers, mountain rescuers, coast guards, hospital
trauma care personnel, search and rescue teams, dog handlers, veterinarians, representatives of
non-governmental organisations, clean-up and construction workers, health and social welfare
workers as well as faith groups and volunteers.
It is important to recognise the potential impact on the mental wellbeing of rescue workers, aid
workers and health care and other volunteers and staff who are involved in emergencies, as
these people provide essential services during both the response and the recovery. The
psychosocial and mental health impacts on response and recovery workers tend to be less
intense than they are on people who were directly affected, but can still be significant.
Several reasons may explain this level of impact. For example, response and recovery workers
may have greater exposure to stressful contexts as they continue to help people through a post-
disaster adaptation period. Alternatively they may experience a lack of support as their
organisations become increasingly overloaded and are unable to staff their core functions
without putting their personnel under increasing and cumulative strain. It becomes critical then
20 Framework for Psychosocial Support in Emergencies
to encourage organisations and individuals to reflect on the contexts in which they are
operating, in order to take measures that protect them from significant harm.
A number of organisations (eg, Red Cross) have provided support tools for these groups to help
them to identify causes of stress, individual signs of stress and strategies to reduce the impact.
People with disabilities
People with disabilities are disproportionately affected by emergencies. The limited research in
this area indicates that they are at higher risk of injury, death, loss of property and difficulties
during sheltering. This increased vulnerability is due to interrelated individual, environmental
and social factors, such as low income and employment rates, social stigmatisation, poor
housing, secondary complicating health conditions, reliance on others and potential lack of
access to basic care and services.
Disadvantaged and marginalised groups
Emergencies do not affect all members of society equally and can increase existing
disadvantages such as low income, low employment, lack of social support networks, social
stigmatisation, poor-quality housing and barriers to accessing appropriate services and care.
Therefore certain groups of society, such as those with lower socioeconomic status, migrants,
former refugees and the homeless, may be at higher risk of negative consequences after an
emergency.
People with pre-existing mental health disorders
People with pre-existing mental health disorders are especially vulnerable to the impacts of an
emergency. Research indicates that having a mental health disorder before an emergency is one
of the most important risk factors for post-emergency mental health disorders. This group may
include:
people who have had a mental health disorder in the past but are currently in a good state of
mental health and wellbeing
those with active mental health disorders who need continued care.
In the inevitable stress and disruption following an emergency, they may be displaced from their
homes and be at risk of abandonment, neglect and abuse. Without their usual therapeutic and
emotional support networks, they may not recognise the risks that their condition or new
circumstances may lead to a relapse, or they may be unable to receive essential medication or
care.
The stress associated with an emergency may trigger a relapse or increase in existing symptoms
for people with a history of mental health problems. The often explicit and wide media coverage
of emergencies can increase such stress. People with mild to moderate mental health problems
may present at primary health care or emergency facilities with unexplained, somatic
complaints. By contrast, those with severe mental health disorders may not seek help at all, for
reasons such as isolation, stigma and fear of being rejected, lack of knowledge or awareness of
their own situation, or limited access to services.
Therefore, it is critical that primary care and specialist mental health services have
arrangements for business continuity in emergencies in order to protect these groups from
relapse into further mental health disorder or from a worsening of existing problems.
Framework for Psychosocial Support in Emergencies 21
Secondary stressors
Secondary stressors are circumstances, events or policies that are indirectly related to or are a
consequence of an emergency event, which result in emotional strain among affected individuals
and make it more difficult for them to return to what is perceived as normality. Examples of
secondary stressors include ongoing financial strain, conflict in families and couple
relationships, job insecurity and/or loss, difficulties in insurance claim settlement, repeated
relocations, and having to give up pets when moving to other accommodation.
For some people, the secondary stressors that follow from the disruption and dislocation an
emergency creates may have a greater impact than the primary event. These ongoing,
unresolved factors may result in emotional distress and hinder people as they try to reconstruct
their lives, livelihoods, families, social attachments and communities. Research indicates that
the role of secondary stressors in developing and maintaining significant distress may have been
underestimated and may significantly delay and complicate people’s adaptation after an
emergency. It is critical to understand secondary stressors as a significant risk factor and to take
steps to learn about their nature in each emergency so that they can be reduced effectively.
Adaptive factors The process of developing individual psychosocial resilience is not linear. It involves positively
adapting, continuing to develop personally in response to adversity and change, rather than
being a stable goal to be reached. It also involves dynamic interactions between a person and the
wider social, physical and cultural environments, as well as a range of individual characteristics
and reactions to acute or chronic stressors. Table 2 summarises potential adaptive factors.
The primary adaptive factor consistently identified in research and reflected in evidence-based
practice is social support. Social support is the perception and reality that you are cared for,
have help available from other people and are part of a supportive social network. These
supportive resources can be emotional (eg, nurturance), tangible (eg, financial assistance),
informational (eg, advice) and companionship (eg, sense of belonging).
Both perceived levels of social support available and actual support received, particularly from
family, whanau and friends, buffer the effects of stress and can reduce the prevalence of distress
and psychological symptoms. Support from community and agencies is also important.
The community’s participation and involvement in ongoing recovery builds trust and
engagement. Strong social infrastructure, such as social connectedness, networks, social capital,
social identity and attachment processes, has an important role in advancing emergency
response and recovery.
‘Social capital’ refers to resources (such as information, aid, financial resources, and practical,
emotional and psychological support) accessed through social connections. The social
connections may be:
among close network members (bonding social capital)
across heterogeneous networks and organisations (bridging social capital)
extending to higher levels of government or to those in positions of relatively high power and
status (linking social capital).
22 Framework for Psychosocial Support in Emergencies
Social capital includes social networks and the norms of reciprocity and trust, which are vital to
help prepare for and recover from an emergency. While trust has been shown to increase within
communities and towards strangers following emergencies, in certain circumstances trust
within communities can be eroded, such as when:
people are competing for scarce relief and recovery resources
some have more information than others
people are displaced and forced to migrate to other communities.
Emergencies can dramatically alter the physical and social landscape and, as a consequence, can
cause individuals to re-evaluate their sense of place. This sense of place consists of three aspects:
1 place attachment – the positive cognitive and emotional bond that develops between
individuals and their environment
2 place identity – a part of each individual’s self-identity as it relates to their physical
environment
3 place dependence – an individual’s perceptions about how suitable a given place is to
meet their needs and desires.
Following an emergency, people may lose confidence in the norms, networks and mutual trust
that are supposed to protect them and allow them to interact with institutions. This feeling has
been defined as ‘loss of place’. Psychosocial interventions can aim to re-establish a ‘sense of
place’ to make up for this loss.
For Māori, healthy ecosystems (with greater life-supporting capacity) are clearly linked to
people’s cultural and spiritual wellbeing (Harmsworth and Awatere 2013). When an emergency
has a negative impact on the environment, it may have a negative impact on Māori wellbeing.
The Māori cultural concept of kaitiakitanga – stewardship or guardianship of the environment –
is seen as an active rather than passive relationship (Roberts et al 1995). This means that there
is an explicit and highly valued link between the environment and people’s wellbeing that needs
care and repair when the environment is damaged, as well as being a source of strength and
resilience.
People’s attachment to precious objects also needs to be considered in emergencies. Practical
items such as identity documents and insurance details are very important in sorting life out
after an emergency. But loss of other possessions can significantly disrupt a person’s sense of
identity and meaning. Possessions may often communicate what is important in people’s lives.
Although such meanings may not be obvious to others, they will be for the owners, who gain a
sense of pleasure, attachment or wellbeing, and a deeper sense of identity from them. Therefore,
loss of important possessions such as photographs or family heirlooms may impact on a
person’s recovery and wellbeing after a disaster. The preparedness stage should include steps to
identify treasured items, while the recovery stage should include help to recover such
possessions if possible.
Framework for Psychosocial Support in Emergencies 23
Table 2: Summary of adaptive factors
Adaptive factors
Being in a marital or de facto relationship
Higher socioeconomic status
Being in employment
Ability to plan and manage their recovery with an understanding of their whole situation
Secure sense of identity
Help from others:
information
tangible support
social support
emotional support
Individual coping:
sense of safety
hope
efficacy
arousal management (eg, self-soothing abilities)
problem-solving abilities
helpful thinking strategies
emotional coping abilities (eg, reframing, acceptance, humour)
activities that are pleasurable and give a sense of mastery, including returning to normal routines
Community coping and adaptation:
working with, helping and staying connected to others
collective problem solving and collective helping
keeping up social and support networks
focusing on values and spirituality
Distraction can help in the short term. Being engaged in other activities offers respite from constantly trying to engage with emergency-related problems that need addressing
For children, a family or whanau that provides warmth, support, consistency, predictability and a positive coping strategy. Being able to successfully regulate emotional experience also helps
Personal psychosocial resilience in which people:
perceive that they have and are able to accept help
have strong acceptance of reality
have belief in themselves underpinned by strongly held values
have the ability to improvise
Source: Adapted from Williams et al (2008)
24 Framework for Psychosocial Support in Emergencies
Strengthening and enabling
service delivery
The majority of people adapt to post-emergency environments well, drawing on their own
resources and the support of their families and communities. For the minority of people, and for
some aspects of community functioning, psychosocial recovery can take many years.
Providing effective psychosocial interventions requires:
collaborative partnerships based on clear roles and responsibilities and effective leadership
careful planning
good training and support for personnel at all levels and in all agencies
engaged, informed and resilient communities
effective communication
regular monitoring and evaluation.
Well-coordinated and well-resourced psychosocial interventions can support many people in
affected communities to adapt after an emergency. Such interventions can also assist people to
help others.
Care must be taken to carry out community-level assessments so that resources are targeted to
provide effective psychosocial interventions when and where they are needed. This means
conducting both needs assessment and analysis of the psychosocial context in parallel. It is
important not to withdraw resources too early to avoid creating any resource gaps after
spending the initial funding allocations. It is also critical to match referrals to existing services
with sufficient funding as the post-emergency period progresses, so that those services can
maintain and develop their capacity to meet increased workloads.
These enabling factors, relevant across all phases of an emergency, are vital to ensure that
services coordinating, designing and delivering psychosocial interventions continue to
effectively contribute to post-emergency adaptation and recovery in the long term. However,
because the psychosocial impacts of emergencies are like ripples in a pond with consequences
reaching out well beyond the primary location of an event, psychosocial support must be the
concern of all providers, locally, regionally and nationally.
Framework for Psychosocial Support in Emergencies 25
Leadership and coordination Effective leadership and coordination across multiple agencies before, during and after an
emergency are vital for an effective response to and recovery from the emergency. Flexible and
coordinated responses are based on strong local partnerships, clear roles and responsibilities,
and transparent care and referral pathways between services and agencies.
Organisations, groups and communities that have strong day-to-day relationships are generally
more likely to function well following an emergency. Relationships based on trust and shared
understanding can be fostered through information sharing and both formal and informal
interactions such as training, workshops, and joint planning and exercises. These relationships
are dynamic and will encompass a range of diverse actors, bringing different valued capabilities,
capacities and resources to emergency response and recovery. Inevitably, these actors will vary
in size (eg, national, regional, local) and other dimensions (eg, proportion of staff who are
voluntary or paid, or whether they are established or emergent organisations). These differences
should be acknowledged and proactively managed to ensure effective cooperation and
understanding.
National telephone helpline
Where appropriate, national resources can be engaged to support local and regional
response, especially where issues such as population movement are involved. One possible
approach is to develop regional reciprocal relationships that allow an organisation to
increase its capacity and staff cover during an emergency so that it can initiate and sustain
psychosocial interventions and mental health assessment and treatment. Another resource
to be aware of is Healthline.
Healthline is one of a number of integrated, national-level telehealth operations that take
advantage of technological opportunities to deliver flexible and adaptable services to meet
identified needs. When needed, this telehealth and disability service has the capability and
capacity to support psychosocial initiatives and interventions, as well as mental health
assessments and referrals. It can provide this support through personal interactions in
voice calls with registered nurses and mental health and addictions specialists, online
interaction and personalised automated advice through online assessments and guides,
supported by website self-help and health information.
The Ministry of Health and the Accident Compensation Corporation co-fund Healthline.
The service is free of charge to users and available 24 hours a day, seven days a week.
Roles and responsibilities The National Health Emergency Plan (Ministry of Health 2015) specifies the general roles and
responsibilities of the health and disability sector (including all providers of psychosocial
support services) across all components of emergency management. These roles and
responsibilities include:
planning for functioning during and after an emergency
being capable of continuing to function to the greatest extent possible (even though at a
reduced level) during and after an emergency
developing, reviewing and improving emergency plans
responding to the emergency as required.
26 Framework for Psychosocial Support in Emergencies
The Ministry of Health and district health boards (DHBs) are the agencies responsible for
coordinating psychosocial support during and after an emergency.
At the national level, the Ministry of Health is responsible for coordinating the provision of
psychosocial support and provides the required health and disability services by funding,
planning and providing services, including by contracting organisations.
At the Civil Defence Emergency Management Group level, DHBs are responsible for
coordinating the provision of psychosocial support services.
DHBs advise non-governmental organisations and primary health organisations on the type
and nature of services needed for ongoing psychosocial support.
Welfare Services in an Emergency: Director’s guideline (Ministry of Civil Defence and
Emergency Management 2015b) provides information and guidance about the welfare roles,
structures and responsibilities described in the Guide to the National Civil Defence Emergency
Management Plan (Ministry of Civil Defence and Emergency Management 2015a). The
Director’s guideline (Ministry of Civil Defence and Emergency Management 2015b) lists the
agencies that may be required to provide support to the psychosocial support sub-function.
DHBs cannot, and should not, be the sole providers of psychosocial interventions. Many
actors across the DHB regions and the wider health sector can and should be involved, for
example, public health units, primary care, non-governmental organisations and specialist
mental health services. The DHBs’ role is to coordinate agencies and groups (both in the
health sector and from the wider welfare sector) and to advise them on the type and
nature of interventions, services and initiatives needed for ongoing psychosocial support.
Planning Planning is essential to effectively reduce and manage psychosocial impacts of emergencies. It is
an integral part of the readiness process and psychosocial support providers must be involved in
all phases and aspects of planning.
All agencies and groups providing psychosocial interventions must undertake planning and
preparedness activities to ensure that they can fulfil their roles and contribute to an effective
response and optimal recovery.
Effective planning is a cyclical, deliberate process of building a programme of interrelated
activities that are flexible and responsive to differing types of emergencies. Key planning
activities include:
communicating and consulting
assessing and monitoring risk
monitoring and reviewing arrangements
educating and training personnel
developing and maintaining relationships and communication with relevant partners,
stakeholders and communities
rehearsing, exercising and testing plans, including the psychosocial support plan.
Framework for Psychosocial Support in Emergencies 27
The problem is that disaster plans are too often designed around the most recently
impacting event, which, in probability, may not be the event that occurs next. It is a
challenge to maintain a pool of disaster experience and of staff who are interested in the
absence of a real threat (McFarlane and Williams 2012, p 9).
Training considerations To effectively carry out psychosocial interventions and recovery plans and actions during an
emergency, it is necessary to train, manage and support personnel to prepare them for their
roles and responsibilities across all phases of an emergency. All those involved in planning or
delivering psychosocial interventions to affected individuals and communities should receive
ongoing training, support and supervision. This includes ensuring that those involved in
delivering mental health care treatments have a good understanding of where they fit in the
system.
As the needs of those affected by an emergency increase, so does the need for training for those
providing psychosocial interventions. Training should, therefore, be targeted according to the
activities that individuals will be engaged in and the level they will be working at. The following
are three important levels of training to consider.
Foundation training
Foundation training is primarily for people actively engaged in the community and in direct
contact with people affected (eg, health sector workers such as general practitioners and nurses,
local government staff, non-governmental organisation personnel, school teachers and
principals, and others involved in community-based psychosocial activities). The training
should provide a basic awareness and understanding of: the idea of normal reactions to
abnormal circumstances; the psychosocial context and impact of potentially traumatic events on
individuals and communities; the reactions people are likely to have; how helpers’ actions may
help or hinder the recovery of others; signs that a person is struggling; where to get help and
support; and how to refer people for more specialised interventions.
An example of how those trained to this level might use their training is psychological first aid
(PFA). This is an approach for helping people immediately after an emergency to reduce initial
distress and to foster their adaptive functioning in the short and long term. The PFA training
provided by New Zealand Red Cross also includes considerations for working with Māori.
Foundation training should also be offered to media partners. Good relationships and shared
understanding with media partners contribute significantly to the success of efforts to influence
the psychosocial context to promote better health and wellbeing for affected communities.
Tier 1 training
Tier 1 training is for trained professionals (eg, psychologists, social workers, counsellors)
providing psychosocial interventions to those affected by the emergency, including interventions
that target the psychosocial context (eg, parenting workshops and peer/professional
collaborative groups), or those interventions or initiatives targeted at a population level. The
purpose of the training is to:
28 Framework for Psychosocial Support in Emergencies
give the professionals skills and knowledge that are specific to the needs of individuals and
communities following an emergency
build their capacity to comprehensively assess physical, psychological and social needs and, if
necessary, accept referrals for the 15–20 percent of people (see ‘Longer-term reactions’) who
may require more help than psychosocial interventions in the community offer.
When people are trained at this level, they may provide interventions such as psycho-education
programmes for affected community members, and skills for psychological recovery, which is
usually provided by psychologists, social workers or counsellors with specific training in
community disaster response. (See more about possible interventions at this level under
‘Psychosocial interventions’.)
Tier 2 training
Tier 2 training is for professionals with previous training and expertise in providing specialist
mental health treatment services (eg, clinical psychologists, psychiatrists, other specialist
mental health practitioners). The training should add to their existing skills by providing them
with an advanced understanding of the needs of existing and new mental health clients affected
by the emergency.
Professionals trained to this level can undertake evidence-based clinical interventions such as
trauma focused cognitive behaviour therapy for children and adolescents and other such
evidence-based treatments for adults. However, it is the responsibility of mental health service
providers to ensure that the clinical basis for using particular treatment protocols and
interventions is well-matched to the individual, family, whanau or community in need by
conducting a well-planned assessment and considering available and evidence-informed
options.
Communication Effective communication with those affected by emergencies and with the wider public is
fundamental to psychosocial recovery. Communication has a critical role in all areas of
emergency management, ranging from informing people of likely threats and preventive action
through to enabling people to take responsibility for their own recovery.
Those agencies that are responsible for psychosocial support services should consider how the
communications strategy impacts on, and can contribute to, psychosocial recovery. It is also
important to recognise the two-way nature of communications, to listen to those affected and to
use this information effectively in developing recovery plans and activities.
Some key considerations are to:
acknowledge loss and grief
inform the affected population about the emergency, relief efforts and their legal rights
provide access to information about normal responses over time and positive coping methods
get information about the situation and people’s concerns and provide it honestly and openly,
and at levels that they can understand
use a range of communication channels, including written leaflets, websites, social media,
telephone helplines and outreach (door knocking). It may be necessary to repeat
communications and to deliver them in multiple formats that are short and easy to absorb
and understand, acknowledging that people may have difficulty concentrating during and
after an emergency
Framework for Psychosocial Support in Emergencies 29
ensure staff working with the media follow a coordinated communications strategy
if holding informal community meetings, be prepared to answer questions and act on
community concerns. Such meetings can be helpful and reassuring for affected communities
if handled sensitively but honestly. Think carefully about which staff speak at these meetings
(ie, they should be suited to a public engagement role) and what preparation they need to
fulfil this role.
Engaged, informed and resilient
communities Supporting individuals, families, whanau and communities to recover from emergencies
requires a community-based approach that strives to include community members in all aspects
of psychosocial recovery. These aspects include planning and preparedness, assessment of
needs, programme development and implementation, and monitoring and evaluation.
Today, the idea of community means more than the physical infrastructure of a human
settlement. Communities are made up of dynamic, networked groups of people who share
common places, values, interests, and cultural, religious or other social characteristics. They
also have the capacity to influence their basic common needs given their particular social and
political context.
Resilience building is an ongoing adaptive process, not an end-state to be achieved. It
includes complex, interrelated and dynamic elements, such as social connectedness,
reciprocity and trust.
There are many different theories about, and approaches to, developing community resilience.
Given communities and their social and economic contexts are enormously diverse, no single
approach will apply to all of them.
A number of authors have identified various key dimensions or attributes of community
resilience. According to the Post Carbon Institute (Lerch 2015), important foundations for
effectively building community resilience are:
people – it is community members who have the power to envision the future of the
community and build its resilience
systems thinking – essential for understanding the complex, interrelated crises now
unfolding and what they mean for our similarly complex communities
adaptability – a community that adapts to change is resilient. But because communities and
the challenges we face are dynamic, adaptation is an ongoing process
transformability – some challenges are so big that it’s not possible for the community to
simply adapt; fundamental, transformative changes may be necessary
sustainability – community resilience is not sustainable if it serves only us, and only now; it
needs to work for other communities, future generations and the ecosystems on which we all
depend
courage – as individuals and as a community, we need courage to confront challenging issues
and take responsibility for our collective future.
30 Framework for Psychosocial Support in Emergencies
Community resilience can only be supported through meaningful engagement that enables a
community to work together to understand and manage the risks that it faces; feel supported to
take ownership of psychosocial recovery plans and activities; and to care for each other. To
achieve active community participation, it is important to:
engage with communities proactively and meaningfully
support and enhance existing networks, activities and services
base activities on existing strengths and identified unmet needs
enhance self-reliance for all individuals, families, whānau and groups in communities
ensure that professional psychosocial support services and interventions do not reduce
opportunities for self-determination, increase existing inequalities or create new inequalities
or vulnerabilities
meet the specific needs of individuals, families, whānau and communities where practicable.
Tools for understanding your community better
Designing an intervention involves the stages of: assessing and evaluating needs; planning
an intervention; engaging stakeholders; implementing the intervention; and ensuring
sustainability. Several tools can help with this work.
Public health approaches described by The Guide to Community Preventative Services
(Community Preventive Services Task Force 2016) offer established and evidence-
informed tools to identify evidence gaps, support collaborative planning, support
implementation and the monitoring and evaluation of interventions for ongoing
learning and improvement.
HealthyPeople.gov offers MAP-IT, a helpful framework for intervention design, which
outlines a path to successful programmes – mobilise, assess, plan, implement and
track. It includes a toolkit with helpful questions to address as you progress through
each of these stages (Office for Disease Prevention and Health Promotion 2016).
Guidance for engaging and communicating with culturally and linguistically diverse
communities is also available (Christchurch City Council 2012).
Information gathering, monitoring and
evaluation All agencies providing psychosocial support are responsible for monitoring and evaluating their
activities. Under the National Civil Defence Emergency Management Plan Order 2015, agencies
are expected to monitor and evaluate their capacity and capability to respond to and help with
recovery from emergencies by:
measuring their performance against standards, benchmarks or performance indicators
exercising and testing their capacity and capability
analysing their effectiveness
tracking their progress towards goals and objectives
monitoring their compliance with the Civil Defence Emergency Management Act 2002.
Monitoring is an iterative process of gathering and analysing data with the goal of determining if
the resources, activities and interventions provided are supporting individuals and communities
in their psychosocial recovery. Monitoring may address a range of issues or questions.
Framework for Psychosocial Support in Emergencies 31
How well are the provided (and planned) activities and resources working?
– Are they being implemented and used as planned?
– Are they relevant to and meeting the identified needs?
– Are they realistic and relevant to the intended aim(s)?
– Are they effective?
How well are ongoing needs being addressed?
– Have new issues been identified that need to be dealt with?
– Are existing services meeting identified needs?
– Have new opportunities for supporting psychosocial recovery emerged?
– Have the targeted population or the external environment changed in ways that affect
planned activities?
What monitoring is in place?
– Are ongoing and additional threats and stressors being monitored?
– Is there monitoring of the management of media coverage and public perception?
Monitoring should follow key research and evaluation principles to ensure that the quality of
study designs and methods is good enough to allow valid conclusions to be drawn from the
findings. It should occur at individual, community and societal levels. Wherever possible, the
psychosocial support indicators and instruments used should be well-established and previously
reported, and have standardised administration procedures.
Coordinating information gathering and sharing
As far as possible, strike a balance between respecting important privacy concerns and
relieving the affected community member of the need to tell their story over and over
again. Develop a core body of non-sensitive information that responsible and credentialed
professionals can share – with permission – without logging information that may
inadvertently be passed on to others. Be particularly careful where domestic violence
and/or child protection may be a concern, or in other situations of increased vulnerability.
As psychosocial recovery is highly complex and dynamic, monitoring is an ongoing activity.
Additional information should be collected through evaluations that objectively assess the
degree to which activities or programmes achieved the intended goals or overall objectives.
Usually more comprehensive and costly than monitoring activities, evaluations provide useful
information for future planning and programme development.
Some core evaluation criteria are that the activity or programme should:
be relevant (is appropriate to identified needs and resources)
be efficient (has been implemented successfully in the intended timeframe and at lowest cost)
have impact (produces changes that have the desired effect)
be effective (achieves its objectives)
be sustainable (its benefits are likely to continue).
Given the importance of information gathering, monitoring and evaluation, it is recommended
that service providers develop partnerships with academics and researchers who can provide
expert advice on robust methodology.
32 Framework for Psychosocial Support in Emergencies
Delivering psychosocial
support
Psychosocial interventions can have significant impacts on individuals, families, whānau and
communities. They focus on promoting health and wellbeing, adaptive functioning and the
connectedness between individuals and the psychosocial contexts in which they live.
Interventions may be targeted at the individual level, improving psychological, behavioural
and/or biological functioning; or at the family, whanau or community level, improving the
overall psychosocial context. For example, a community initiative to improve awareness of and
access to green spaces and to encourage exercise may improve family, whanau and community
connectedness through group activities. For individuals, the same intervention may reduce
excess stress hormones (biological level) and promote relaxation and better sleep (behavioural
level).
Although treatments for mental health disorders and psychosocial interventions require
different approaches, they are closely related. Psychosocial problems that persist over a long
time or become very severe without intervention can lead people to develop mild, moderate or
even severe mental health disorders. Equally, people with mental health disorders can have
psychosocial problems. Psychosocial interventions aim to help individuals improve their
wellbeing and may be part of a package to assist those with mental health disorders. However,
given psychosocial interventions may not be strong enough to help those with more acute or
chronic reactions after an emergency, mental health assessments should be considered for these
individuals. In general, psychosocial interventions tend to focus more on influencing the
psychosocial context to promote health and wellbeing, rather than being individually tailored
treatment packages focused on mental health disorders.
Traditionally, mental health treatments have focused on individual functioning, using
pharmacological and/or talking therapy approaches to improve mental health and wellbeing.
This same approach applies after an emergency. Mental health treatments should be delivered
using a stepped-care approach, enabling people to access appropriate help as assessed by need.
Although the majority of mental health treatments target individual psychological factors, as
well as biology and behaviour, treatments can also cross into the psychosocial context, for
example, through the use of family therapy.
Framework for Psychosocial Support in Emergencies 33
Key elements in providing psychosocial
support
Ensure access to basic services and security. Immediately after an emergency, the
priority is to remove threat to life, and then to meet immediate physical care needs and
protect survivors from further harm and trauma. Physical comfort, practical advice,
reassurance and emotional support should be provided with respect, empathy and
flexibility. Encourage self-care and planning.
Inform those affected by the emergency openly and honestly, in a way they can
understand and using a variety of methods. Provide information about the emergency,
relief efforts, their legal rights, normal responses and positive coping methods.
Normalise psychosocial reactions to emergencies. Some level of distress after an
emergency is almost universal and is much more widespread than mental health
disorders. Because people may have difficulty identifying and connecting with their
emotional reactions, they should not be put under pressure to share or re-experience the
events and/or their feelings before they are ready or able to. Do not promote the
expectation that mental illness is an inevitable outcome of emergencies.
Restore relationships of individuals, families, whanau, groups and communities and
support those structures that support people to undertake their own recovery. Promote
conditions for communities to own and control the recovery and provide ongoing
opportunities for networking and engagement.
Coordinate and deliver appropriate psychosocial interventions and mental health
treatments to affected individuals based on clearly identified need.
Maintain ongoing access to timely mental health care for those people with persistent
psychosocial problems and/or showing delayed indications of mental health disorder.
Withdrawing or downscaling services too soon can hold back long-term psychosocial
recovery.
Mobilise existing psychosocial and mental health services and embed psychosocial
initiatives and interventions into the overall support and recovery system in a coordinated
and integrated manner.
Prepare to allocate resource flexibly within and across services to meet identified and
changing need.
Train and support all staff and volunteers involved in planning and delivering
psychosocial interventions to give them the awareness, understanding, skills and
knowledge they need to fulfil their roles. Monitor and support service providers for
possible secondary traumatisation and burn-out symptoms and provide information about
self-care. Ensure they are aware of their responsibility of doing no harm and understand
the idea of normal reactions to abnormal events.
34 Framework for Psychosocial Support in Emergencies
Identification of psychosocial support needs No matter how long the post-emergency period continues, delivering timely and appropriate
psychosocial interventions to support affected individuals and communities must be based on
the accurate assessment of psychosocial problems and associated need. This is crucial to
effectively coordinate and deliver interventions that provide psychosocial support.
Unlike physical injury, psychosocial problems are seldom obvious. It is through purposeful
assessment actions and procedures that they are best identified.
The most effective interventions are those chosen on the basis of an assessment that considers
people’s emotional, social, physical and psychological wellbeing needs within their psychosocial
context. By targeting interventions based on assessed need and with an understanding of the
psychosocial context, it is possible to use limited resources in the most effective way and avoid
the potential harm of inappropriate or unneeded treatments.
The type of assessment used will vary according to when it is conducted in the post-emergency
period. Immediately after an emergency, people are likely to experience symptoms of distress
(see Table 1), though relatively few are likely to develop long-term or clinically significant
problems. As the degree of disruption and loss becomes clearer, it is important to identify
people in immediate and clear need of specialist mental health services. However, in general it is
inappropriate to make assumptions about mental health disorders in the early post-emergency
phase, and more appropriate to practise ‘watchful waiting’; that is, an active surveillance
approach that allows time to pass before beginning any treatment. Watchful waiting does not
mean doing nothing. Rather, it monitors individuals (eg, when they consult with a health
professional) or communities (eg, in terms of patterns of appointments at services by people
with specific concerns) as a way of judging whether an intervention or treatment is warranted.
As the recovery period draws out, the impact of secondary stressors becomes more significant
and it can be difficult to distinguish between the symptoms of severe and/or prolonged distress
and mental health disorders such as PTSD. Generally the difference lies in the severity and
duration of stress, the impacts of interventions offered, and the course that the stress
experiences and symptoms take. It is important, therefore, that any assessment and diagnosis of
mental health disorders at this stage includes an assessment of the continuing impact of
secondary stressors.
Assessment must be undertaken at individual (personal clinical evaluation) and community
(screening and surveillance) levels. Ideally, pre-emergency planning and readiness activities
have been developed based on knowledge of a community’s mental health, vulnerabilities,
resources and capacities – that is, the psychosocial support context (see Figure 1).
It is important to assess community psychosocial wellbeing and mental health needs after an
emergency in order to:
identify people at increased risk
guide the allocation of limited resources
inform the development of targeted psychosocial support interventions.
Surveillance and screening can be used to identify individuals at risk for mental health
problems. However, it is important to recognise that symptom-screening instruments are not
diagnostic tools that provide individual assessments or population-based prevalence estimates.
Ideally, a positive result from screening is followed by a clinical assessment. Following up in this
Framework for Psychosocial Support in Emergencies 35
way, however, will be challenging after an emergency in which screening identifies many people
have been exposed to greater risk.
The type of surveillance and screening tools used should be acceptable to those being screened.
Their content should also be appropriate to the context and phase of the emergency. They
should be clear, concise and easy to administer and score.
To undertake the challenging task of community assessment, it is necessary to use appropriate
strategies, measures and sampling techniques. Data can be collected by using focus groups, case
studies and surveys and by searching private or public databases (eg, to identify changes in help-
seeking behaviour).
Results from self-report symptom surveys must be interpreted with care. They cannot provide
valid prevalence estimates of mental health disorders, but only rough estimates of the mental
health of a community. It is also important to differentiate between:
prevalence rates, which show the proportion of a population who have (or had) a specific
illness/disorder in a given period, regardless of when they were first diagnosed
incidence rates, which measure the number of new cases arising in the population over a
given period (eg, over a month or a year after an emergency).
Psychosocial interventions Following assessment, people must be offered appropriate interventions on the basis of their
identified need. To identify an appropriate intervention, a health professional must understand
the dynamic nature of the psychosocial context (see Figure 1), as well as having clear processes
that are agreed in advance and included in the plans.
The majority of people experience normal stress reactions. Immediately after an emergency,
people’s primary concerns are about their safety and physical needs such as food, shelter and the
desire to be reunited with their loved ones. Psychosocial support interventions provided during
this period are usually brief and focused on the immediate present need. They aim to reduce
distress, provide information and support, and normalise stress reactions.
These early interventions are indicated for the majority of those affected by an emergency and
are not considered formal treatment for mental health disorders. They are usually provided in
community settings by a range of agencies.
Early response to emergency events
When planning how to respond in the early stages after an emergency, be aware that
practical, pragmatic support delivered with empathy is likely to strongly complement the
high levels of resilience that most people exposed to potentially traumatic events show.
This support is less likely to be a psychological treatment in the early stages; rather, it will
be more psychosocial in nature with key elements that address people’s basic needs such
as housing, finances and nutrition. The evidence is not clear enough for us to prevent
disorder, but we can make it easier for people to adapt and respond with resilience by
increasing their access to protective factors and practices and working to remove or reduce
further hazards (Bisson et al 2007).
36 Framework for Psychosocial Support in Emergencies
Many of the psychosocial interventions currently in use are not supported by empirical
evidence, and emergency contexts and outcomes vary widely. For these reasons, it is not
possible to make definitive recommendations about effective intervention approaches, as there
is no one-size-fits-all approach. While a lack of evidence does not necessarily mean a lack of
effect, those providing psychosocial interventions should always do so with caution to ensure
that they do no harm with the methods they choose.
The following is an evidence-informed summary of commonly used psychosocial interventions,
including psychological first aid, critical incident stress debriefing, crisis counselling and
psycho-education. Other interventions involving psychosocial aspects as well as practical aid
and support include telephone helplines and coordination/case management services.
The information below is based on the best evidence available at the time of writing. Given the
complex and dynamic nature of knowledge about psychosocial interventions, it is advisable that
service providers keep a watching brief to stay up to date with any significant changes in
evidence-informed good practice recommendations.
Psychological first aid
Definition and goal: Psychological first aid (PFA) is not a specific intervention but rather an
approach that draws on many interventions from a wide variety of sources. Clinicians or non-
clinicians may use it to reduce the initial distress caused by traumatic events. The goal is to
stabilise psychological and behavioural functioning, support people to adapt psychologically and
behaviourally, and help them to access further care if indicated.
Elements: The elements of psychological first aid are establishing contact through a calm,
comforting and compassionate presence; meeting basic physical needs and protecting
individuals from further harm; listening and information gathering; helping survivors to express
their needs and concerns; meeting basic psychological needs; delivering accurate and timely
information about disaster operations and available resources; providing social support and
coping assistance; and helping people to connect to social support networks and get referrals for
ongoing care. It can be delivered in various settings, including homes, as well as shelters,
medical triage areas, disaster assistance centres, workplaces, schools and other community
settings.
Evidence: PFA is seen as an ‘evidence-informed’ approach that is culturally informed and
appropriate for developmental levels across all ages and can be flexibly delivered. PFA appears
promising as part of a comprehensive, post-emergency intervention strategy. Despite its
widespread use, the goals of PFA are not always clearly understood when it is used and there is a
lack of empirical evidence demonstrating its effectiveness. This does not mean that PFA is not
effective; rather, its effectiveness is yet to be demonstrated.
Critical incident stress debriefing
Definition and goal: Critical incident stress debriefing (CISD) consists of one or more
individual or group sessions provided hours or days after a traumatic event. The goal is to
normalise survivors’ reactions, process their trauma experiences, address psychological distress
and enhance resilience.
CISD should not be confused with organisational or operational debriefing, which aims
to identify lessons and modify arrangements to improve an organisation’s ability to respond in
future emergencies. The latter has no role in providing individual psychosocial support.
Framework for Psychosocial Support in Emergencies 37
Elements: CISD was designed to relieve trauma-related distress by providing opportunities for
survivors to express their feelings, to understand that their responses are normal reactions to
trauma, and to learn about common disaster reactions in a supportive context. Mental health
workers and disaster responders typically deliver CISD in field settings, such as community
shelters.
Evidence: Research indicates concerns that CISD may cause psychological harm because
recipients may be re-traumatised, the intervention may be insufficient to address the multiple,
complex stressors resulting from disasters and terrorism, and it may prevent people from
seeking further help if they believe they have now received sufficient care. The evidence is
clear that single-session individual psychological or critical incident stress
debriefing should not be used. It is unhelpful, and it can cause harm by encouraging people
who have experienced trauma to talk about what happened when in high arousal.
Crisis counselling
Definition and goal: Crisis counselling is a poorly defined, brief strengths-based psychosocial
intervention delivered by trained, experienced crisis workers and para-professionals. Its goals
are to support survivors, help them to cope and connect them with other services.
Elements: Conduct outreach in non-traditional community settings, provide public education,
offer supportive individual and group counselling, conduct assessment and referral, and link
people to resources and other services if needed.
Evidence: No evidence exists to show crisis counselling is effective immediately after
emergencies. There is also a risk that providing immediate counselling may create a false belief
that a person will not experience any long-term mental health disorders.
Psycho-education
Definition and goal: Psycho-education informs people about psychological reactions after a
traumatic event to reduce the adverse effects by providing a cognitive framework for their
experience. The goals are to support survivors of trauma to see their reactions as expected;
recognise the circumstances under which they should consider seeking further counselling;
increase the use of adaptive ways of coping; and help families and whanau to cope.
Elements: The elements in psycho-education in emergencies are to give information about the
causes of psychosocial distress and about treatment options and to promote self-help and
coping behaviour. It can be provided in individual and group settings.
Evidence: Psycho-education has been used mostly with mental health disorders and evidence
indicates it is acceptable to disaster survivors. However, there is little evidence that it is effective
as a standalone intervention with disaster survivors. Instead, it is recommended that it is
provided as part of the provision of other services.
Skills for psychological recovery
Definition and goal: Skills for psychological recovery (SPR) is designed to follow
psychological first aid in the weeks and months following a disaster or mass violence event. SPR
aims to help survivors gain skills to manage distress and to cope with post-emergency stress and
adversity.
38 Framework for Psychosocial Support in Emergencies
Elements: SPR is not a formal mental health treatment, but uses skills-building components
from mental health treatment that have been found helpful in a variety of post-trauma
situations. These skills including problem solving, scheduling positive activities, managing
reactions, helpful thinking, and building healthy social connections.
Evidence: As yet, there is little evidence on the effectiveness of SPR. However, research
suggests that a skills-building approach is more effective than supportive counselling.
Problem management
Definition and goal: Problem management + is a low-intensity psychological intervention for
adults who are impaired by distress in communities that are exposed to adversity. The
programme aims to address both psychological problems (eg, stress, fear, feelings of
helplessness) and, where possible, practical problems (eg, livelihood problems, conflict in the
family or whanau).
Elements: Aspects of cognitive behavioural therapy have been changed so that it is feasible to
apply them in communities that do not have many specialists. In addition to two assessment
sessions, intervention sessions take place once a week for five weeks. All sessions are individual.
The intervention also allows for involving family, whanau or friends if the client wants to. The
approach involves problem management (also known as problem-solving counselling or
problem-solving therapy) plus selected behavioural strategies.
Evidence: As yet, problem management + has only been tested in Nairobi, Kenya and in
Peshawar, Pakistan. It is designed for use in humanitarian environments where access to
trained mental health care professionals is limited. There is no evidence demonstrating its
effectiveness in New Zealand or countries with a similar profile. For this reason, a watching brief
is recommended for this new protocol.
Coordination/case management support
Definition and goals: Coordination/case management support is designed to provide
personal support to individuals affected by emergencies. Its goal is to help people access the
services they need to recover.
Elements: Elements may vary according to the nature of the emergency but usually include
connecting people with available resources including financial (eg, accessing grants), practical
and psychosocial support.
Evidence: Several studies explored the roles of these services, particularly in rural Australia
and in Christchurch after the 2010 and 2011 earthquakes. These studies focused on use, client
satisfaction and service delivery issues rather than on how these services impacted on levels of
psychological distress.
Telephone helplines
Definition and goals: During an emergency, existing or new telephone helplines have been
used to provide information on services available to those affected by the emergency. The goal is
to give people a point of contact to access information and support.
Elements: Elements may vary according to the nature of the emergency but usually include
providing information about the impact of the emergency and sources of support, and referring
people to specialist services, including counselling.
Framework for Psychosocial Support in Emergencies 39
Evidence: There is little evidence on how these facilities contribute to psychosocial recovery.
Research focuses on how acceptable they are to users and their effectiveness in terms of
providing information and referring callers to appropriate services.
Targeting psychosocial support People do not always seek help even when they need it. Ensuring that all those who do need
psychosocial support receive assistance is a challenge for service providers. It is important that
service providers identify barriers to treatment and use a range of strategies to address them
within the broader community response. Providers must also consider how they can best engage
with all those affected by an emergency, especially those vulnerable to greater risk. These groups
may include children and adolescents, older adults, people with a disability, disadvantaged and
marginalised groups, those with pre-existing mental health conditions and the bereaved.
Strategies for targeting psychosocial support may include:
providing systematic outreach to people in their homes or communities (based on screening
to identify populations at risk)
using novel intervention methods
addressing community mental health literacy through targeted communication strategies
monitoring the population for behaviours (eg, self-harm, aggression, or patterns of substance
misuse) that may indicate risk of mental health problems.
Social media and psychosocial support
Social media can play a helpful and complementary role in psychosocial responses during
and after emergencies, alongside other channels of communication and assistance. For
example, Facebook was used in helpful ways during Cyclone Yasi in 2011. However, it is
critical to understand that, in a changing media landscape, social media is a necessary
means of communication in emergency management but insufficient on its own.
Traditional forms of communication through mainstream media (radio and television),
letterbox drops, and face-to-face communication in individual and /or community
meetings should all continue. People will have changing needs, preferences and access
issues that need to be considered (Taylor et al 2012).
Mental health treatments People will need to be referred to formal mental health treatments if they have indications of a
mental health disorder or experience an acute mental health crisis (such as suicidal ideation) or
if a pre-existing mental health disorder recurs or worsens. The level of need for these specialist
services will become more apparent weeks after the emergency began, as disorders such as
PTSD and major depression emerge and can be diagnosed.
Specialist treatment for mental health disorders is provided following a referral to specialist
trained mental health professionals, usually from primary care providers in first instance. Such
care is usually provided in traditional clinical settings using standardised processes and
protocols. In rare circumstances, specialist mental health treatment may be required in
emergency event locations; ideally this should be integrated into the broader emergency medical
response.
40 Framework for Psychosocial Support in Emergencies
Further information on the
evidence base
Acknowledging the importance of evidence-informed policy and practice, this Framework for
Psychosocial Support in Emergencies was informed by:
a brief survey of end-users
an extensive review of existing international guidance and literature
a review of the draft report by an international technical advisory group.
A review document was produced through an iterative process of summarising and analysing
the key literature, identifying aspects that needed to be reflected in the revised framework and
reworking drafts. A further document published as a GNS Science report provides additional
detail on key aspects from the literature (GNS, in press).
As the body of literature is dynamic, and this Framework represents best evidence available at
the time of writing, service providers are advised to keep a watching brief to stay up to date with
significant changes in evidence-informed good practice recommendations.
Framework for Psychosocial Support in Emergencies 41
References
Bisson JI, Brayne M, Ochberg FM, et al. 2007. Early psychosocial intervention following traumatic
events. American Journal of Psychiatry 164(7): 1016–19.
Christchurch City Council. 2012. Best Practice Guidelines for Engaging with CALD Communities in
Disasters. URL: www.healthychristchurch.org.nz/news/resources-and-information/2012/8/best-
practice-guidelines-for-engaging-with-cald-communities-in-disasters (accessed 1 September 2016).
Christchurch: Christchurch City Council.
Community Preventive Services Task Force. 2016. The Guide to Community Preventative Services.
www.thecommunityguide.org/toolbox/index.html (accessed 1 September 2016).
Durie M. 1998. Whaiora: Māori health development (2nd edition). Oxford University Press.
Harmsworth GR, Awatere S. 2013. Indigenous Māori knowledge and perspectives of ecosystems.
In J Dymond, Ecosystem Services in New Zealand: Conditions and trends. Palmerston North:
Manaaki Whenua Press.
IASC. 2007. IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings.
Geneva: Inter-Agency Standing Committee. URL:
www.who.int/mental_health/emergencies/guidelines_iasc_mental_health_psychosocial_june_200
7.pdf (accessed 1 September 2016).
Kingi-Uluave D, Faleafa M, Brown T. 2007. A Pasifika perspective of psychology in Aotearoa.
In: I Evans, J Rucklidge, M O’Driscoll, Professional Practice of Psychology in Aotearoa New
Zealand. Wellington: New Zealand Psychological Society.
Lerch D. 2015. Six Foundations for Building Resilience. Post Carbon Institute. URL:
www.postcarbon.org/wp-content/uploads/2015/11/Six-Foundations-for-Building-Community-
Resilience.pdf (accessed 1 September 2016).
McFarlane AC, Williams R. 2012. Mental health services required after disasters: learning from the
lasting effects of disasters. Depression Research and Treatment, Article ID 970194, doi:
http://dx.doi.org/10.1155/2012/970194.
Ministry of Civil Defence and Emergency Management. 2015a. Guide to the National Civil Defence
Emergency Management Plan 2015. Wellington: Ministry of Civil Defence and Emergency
Management. URL: www.civildefence.govt.nz/assets/guide-to-the-national-cdem-plan/Guide-to-
the-National-CDEM-Plan-2015.pdf (accessed 1 September 2016).
Ministry of Civil Defence and Emergency Management. 2015b. Welfare Services in an Emergency:
Director’s guideline for Civil Defence Emergency Management Groups and agencies with
responsibilities for welfare services in an emergency (DGL 11/15). Wellington: Ministry of Civil
Defence and Emergency Management. URL: www.civildefence.govt.nz/assets/Welfare-Services-in-
an-Emergency/Welfare-Services-in-an-Emergency-Directors-Guideline.pdf (accessed 1 September
2016).
Ministry of Health. 2002. He Korowai Oranga: Māori Health Strategy. Wellington: Ministry of
Health.
Ministry of Health. 2010. New Zealand Influenza Pandemic Plan: A framework for action.
Wellington: Ministry of Health. URL:
www.health.govt.nz/system/files/documents/publications/nzipap-framework-for-action-
apr2010.pdf (accessed 1 September 2016).
42 Framework for Psychosocial Support in Emergencies
Ministry of Health. 2015. National Health Emergency Plan: A framework for the health and
disability sector. Wellington: Ministry of Health. URL:
www.health.govt.nz/system/files/documents/publications/national-health-emergency-plan-oct15-
v2.pdf (accessed 1 September 2016).
Ministry of Health. 2016. Māori Health Models: Te Pae Mahutonga. URL: www.health.govt.nz/our-
work/populations/maori-health/maori-health-models/maori-health-models-te-pae-mahutonga
(accessed 1 September 2016).
Naturale A. 2015. How do we understand disaster-related vicarious trauma, secondary traumatic
stress and compassion fatigue? In: G Quitangon and M Evces (eds), Vicarious Trauma and Disaster
Mental Health: Understanding risks and promoting resilience. New York: Routledge, Taylor and
Francis.
North CS. 2014. Current research and recent breakthroughs on the mental health effects of disasters.
Current Psychiatry Reports 16(10): 1–8.
North CS, Oliver J, Pandya A. 2012. Examining a comprehensive model of disaster-related
posttraumatic stress disorder in systematically studied survivors of 10 disasters. American Journal
of Public Health 102(10): e40–e48.
Office for Disease Prevention and Health Promotion. 2016. MAP-IT: A guide to using healthy people
2020 in your community. URL: www.healthypeople.gov/2020/tools-and-resources/Program-
Planning (accessed 1 September 2016).
ODESC 2007. National Hazardscape Report. Wellington: Officials’ Committee for Domestic and
External Security Coordination.
Roberts M, Waerete N, Minhinnick N, et al. 1995. Kaitiakitanga: Māori perspectives on conservation.
Pacific Conservation Biology 2(1): 7–20.
Salguero JM, Fernández-Berrocal P, Iruarrizaga I, et al. 2011. Major depressive disorder following
terrorist attacks: a systematic review of prevalence, course and correlates. BMC Psychiatry 11(1): 1.
Taylor M, Wells G, Howell G, et al. 2012. The role of social media as psychological first aid as a
support to community resilience building. Australian Journal of Emergency Management 27(1): 20.
United Nations Office for Disaster Risk Reduction. 2015. Sendai Framework for Disaster Risk
Reduction 2015–2030. URL: www.unisdr.org/files/43291_sendaiframeworkfordrren.pdf (accessed
1 September 2016).
Ursano RJ, Fullerton CS, Terhakopian A. 2008. Disasters and health: distress, disorders, and
disaster behaviors in communities, neighborhoods, and nations. Social Research 75(3): 1015–28.
Waiti J, Kingi TK. 2014. Whakaoranga Whanau: Whanau Resilience. MAI Journal 3(2): 126–39.
Williams R. 2007. The psychosocial consequences for children of mass violence, terrorism and
disasters. International Review of Psychiatry 19(3): 263–77.
Williams R, Alexander DA, Bolsover D, et al. 2008. Children, resilience and disasters: recent
evidence that should influence a model of psychosocial care. Current Opinion in Psychiatry 21(4):
338–44.
Williams R, Kemp V. 2016. Psychosocial and mental health care before, during and after
emergencies, disasters and major incidents. In: C Sellwood and A Wapling (eds), Health Emergency
Preparedness and Response. Wallingford: CABI.
Williams R, Kemp VJ, Alexander JM. 2014. The psychosocial and mental health of people who are
affected by conflict, catastrophes, terrorism, adversity and displacement. In: J Ryan, A Hopperus
Buma, C Beadling, et al (eds), Conflict and Catastrophe Medicine. London: Springer-Verlag.
Framework for Psychosocial Support in Emergencies 43
Appendix 1: Types of hazards
At the national level, the National Hazardscape Report, published by the Officials’ Committee
for Domestic and External Security Coordination (ODESC 2007), identifies and considers the
range of natural and artificial hazards that are relevant to New Zealand from national and
regional perspectives. The report identifies the following 17 types of hazards, all of which have
the potential to cause emergencies that require coordination or management at the national
level:
earthquakes
volcanic hazards
landslides
tsunami
coastal hazards (eg, storm surge and coastal erosion)
floods
severe winds
snow
droughts
wildfires
animal and plant pests and disease
infectious human disease pandemics (including water-borne illnesses)
infrastructure failure
hazardous substance incidents (including chemical, biological and radiological)
major transport accidents (air, land and water)
terrorism
food safety (eg, accidental or deliberate contamination of food).
Source: ODESC (2007)
44 Framework for Psychosocial Support in Emergencies
Appendix 2: Typical short-
term reactions to emergencies
Emotional Shock, disbelief, denial
Anxiety, fear, worry about safety
Emotional numbing, apathy
Depression
Isolation
Grief, sadness, longing and pining for deceased
Helplessness, hopelessness and despair
Powerlessness and vulnerability
Anger, rage, desire for revenge
Irritability, short temper
Blame of self and others, resentment
Survivor guilt
Unpredictable mood swings
Re-experiencing pain associated with previous trauma
Loss of derived pleasure from regular activities
Feeling heroic, euphoric or invulnerable
Difficulty in giving or accepting help
Cognitive Confusion and disorientation
Memory problems, complete or partial amnesia
Impaired concentration, thought processes and decision-making
Repeated flashbacks, intrusive thoughts, memories and images
Dissociation (disconnected, dream-like, or on ‘automatic pilot’)
Obsessive self-criticism and self-doubt
Preoccupation with event or with protecting loved ones
Recurring dreams or nightmares
Reduced confidence or self-esteem
Framework for Psychosocial Support in Emergencies 45
Physical Faintness and dizziness
Hot or cold sensations
Tightness in throat, chest or stomach
Agitation, nervousness, hyper-arousal, startle response
Chronic fatigue, exhaustion, reduced energy
Gastrointestinal problems, nausea
Appetite changes
Weight loss or gain
Headaches
Exacerbation of pre-existing conditions
Impaired immune response
Insomnia, sleep disturbance
Libido changes
Somatic complaints
Visual disturbances
Behavioural and social Jumpiness – easily startled
Hyper-vigilance – scanning for danger, excessive worry
Crying and tearfulness
Interpersonal conflict, irritability
Avoidance of reminders of trauma
Inability to express feelings
Withdrawal from others
Increased use of alcohol or drugs
Excessive activity level
Regression
Changes in activity level
Difficulty communicating or listening
Inability to rest or relax
Decline in job or education performance, absenteeism
Becoming accident prone
Spiritual Questioning of spiritual or religious beliefs
Anger at perceived higher power
Loss of sense of safety
Inability to find meaning
Source: Adapted from Naturale (2015) and Williams (2007)
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